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THE 


FOUNDATION OF HEALTH 

A MANUAL OF PERSONAL HYGIENE 
FOR STUDENTS 


BY 

WILLIAM BARNARD SHARP, S.M., M.D., Ph.D. 

PROFESSOR OF BACTERIOLOGY AND PREVENTIVE MEDICINE IN THE MEDICAL 
DEPARTMENT OF THE UNIVERSITY OF TEXAS, GALVESTON, TEXAS 


ILLUSTRATED 



LEA & FEBIGER 

PHI I, A DELPHI A AND NEW YORK 

1924 





Copyright 
LEA & FEBIGER 
1924 




) 






PRINTED IN U. S. A. 


SEP i o 1924 


©CIA 801780 

I 


PREFACE. 


Too few of our intelligent people share the modern enlight¬ 
enment on personal hygiene and allied health problems. 
Health campaigns always suffer from the inability of the 
public to comprehend their purposes. Leading physicians 
and others who are not satisfied with this popular want of 
hygienic understanding look to the schools for its correction. 
School hygienists urge that the work of all periods of school 
life include some instruction concerning the maintenance of 
health. This text is designed for use in the early college 
years. It is based upon courses prepared for Junior College 
students at the University of Chicago, and for students enter¬ 
ing the study of medicine at the University of Texas. 

I have taken a middle ground between the strictly applied 
and the physiological methods of teaching hygiene. My aim 
is not only to outline hygienic practices, but also to show 
how the functions of the body are affected thereby. If the 
student sees the connection between such practices and the 
health of his body, he is the less likely to be led astray by 
ridiculous fads, or to misapply scientific rules of health. On 
the other hand, too much stress on physiology diverts the 
theme of a short course from practical hygiene. 

With the idea that scattered collateral reading is no less 
valuable than text-book study, I have suggested at the end 
of each chapter some appropriate references. Most of these 
are selected to afford. a broader, familiarity with the better 

■ . , 'J4 . 


IV 


PREFACE 


class of popular literature on personal health. A few inter¬ 
esting and non-technical chapters from scientific hooks are 
also listed for reading, to illustrate the immediate sources of 
our principles of hygiene. 

I am indebted to Professors Edwin 0. Jordan and Dudley 
B. Reed of Chicago and Harry V. Atkinson of Galveston, to 
the Reverend James R. Sharp of Nashville, and to my wife, 
for suggestions and criticisms. Dr. Herman E. Dustin made 
the diagrams and sketches for me, using specimens in the 
collections of the University of Texas. 


Galveston, Texas, 1924. 


W. B. S. 


CONTENTS 


CHAPTER I 

The Problem of Health and Disease.17 

CHAPTER II 

Functions of the Skin.31 

CHAPTER III 

The Membranous Covering.50 

CHAPTER IV 

Infection and Immunity.69 

CHAPTER V 

Reproduction.85 

CHAPTER VI 

The Digestive System.101 

CHAPTER VII 

Respiration and Body Heat.117 

CHAPTER VIII 

Foods and Nutrition.134 

CHAPTFR IX 

Sensation and Motor Control .150 












VI 


CONTENTS 


CHAPTER X 

The Mental Processes. 168 

CHAPTER XI 

Physical Exercise. 186 

CHAPTER XII 

Hazards of Childhood. 201 

CHAPTER XIII 

Health in the Home. 217 

CHAPTER XIV 

The Modern Health Movement. 233 

Index. 249 








THE FOUNDATION OF HEALTH. 


CHAPTER I. 

THE PROBLEM OF HEALTH AND DISEASE. 

Hygiene.— Hygiene is the science of health; while in many 
particulars new, it is in principle very old. The name dates 
back to that of the goddess Hygieia and the Greek work for 
health (uyUta), and even when ancient Greece flourished 
the study itself was old. Health had been written about 
centuries before in Egyptian, and it had stirred man’s thoughts 
before he attempted to write at all. All primitive impulses 
are directed toward a healthful existence. 

The knowledge of health at first was crude and merged 
into mysticism. Observations could not be made with 
refinement until modern science opened the way. Science 
enables us to care for our bodies much more sensibly than 
could our forbears. Recent advances have come so rapidly, 
however, that for many they have confused rather than clari¬ 
fied the issue. To be helpful, they must be so comprehended 
as to augment, and not confusedly supplant, the hygiene of 
common sense which has come down from antiquity. 

Divisions of Hygiene.—Individual or personal hygiene covers 
what each individual should know in order to preserve his 
health. His responsibility is broader in an unhealthful than 
in a healthful locality. The avoidance of intestinal infection 
is an important personal care in Asiatic countries. To drink 
unsterilized water or to eat uncooked green foods there 
would be to invite an attack of dysentery or of typhoid fever. 
This is not the case in other regions with better sanitary 
2 


18 


THE FOUNDATION OF HEALTH 


standards. Principles of personal hygiene are aimed at the 
preservation of one’s health amid existing surroundings. 

In community life, where one disease threatens many 
persons, it is often economical to band together, employ a 
sanitary expert, and treat the problem as a whole. Purifi¬ 
cation of a polluted water supply is an instance. The per¬ 
son’s environment becomes safer by such collective action, 
which constitutes public hygiene. Instead of personally 
guarding his health, the individual surrenders his freedom of 
action and follows the direction of an accepted authority. 
The community decides for the welfare of all, and not each 
of its members for his own welfare. One problem after 
another is passing into the field of public hygiene: Contam¬ 
ination of water and food, contagion, use of habit forming 
drugs, and even the use of alcoholic drinks. 

In the School.— Hygiene has not always attracted the 
attention of the general student, nor has physical health 
always been rated as a scholarly attainment. The ancient 
Greeks emphasized the need of a sound body for a sane 
mind, but the ascetics who kept learning alive through the 
dark ages lost this vision. To them the debasement of the 
body seemed to exalt the mind. Chinese civilization also has 
represented a wide divergence between mental and physical 
well-being; the stoop-shouldered learned classes would have 
abhorred the physique of a coolie laborer. 

Modern scholars, of the West and of the East, idealize 
again the outstandingly healthy body and mind. Football 
and other school athletics are encouraged because they bring 
into the ideals of students the thought of health. Physical 
culture departments may concentrate on the few who least 
need development, but by doing so they lead all the students 
to admire a high physical standard. 

Attainment of Health.— While the athlete is in most respects 
healthy and has always been accepted as a convenient model 
of health, the perfectly healthy individual need not be athletic 
at all. The ancients based their conception of health rather 
loosely on physical prowess and grace of posture, but with 
the advent of modern science the conception has crystallized 
more definitely into that of a proper functioning of all organs. 


THE PROBLEM OF HEALTH AND DISEASE 19 


A model of supreme health might better be sculptured as a 
composite individual with all body functions perfected, about 
as the superman has been described. 

An understanding by each individual of the needs of his 
own functions is the means to better health. Imitation of 
the physical habits of healthy men does not constitute a 
highway to health, because the functional needs of all indi¬ 
viduals are not uniform. While swimming improves the 
health of most boys, it occasionally kills one whom a defective 
heart exposes to cramps. The prize fighter’s enviable health 
can be credited to his pugilistic training, but men without his 
inherent neuromuscular capacity could be injured by such 
a course. The aim of personal hygiene is to have each person 
know how to overcome the impediments of his own bodily 
functions. 

Environmental Hazards.—Raising the function of an organ 
to its greatest perfection only halfway assures the health of 
that organ. The athletic attainments from years of training 
can be wiped out in a day by a rheumatic infection; infection 
is one of the many adverse powers which stand ready to 
contest man’s development. The forces of nature are always 
ready to destroy those who are not protected from them. 
An unguarded child, without intelligent protection, could 
hardly survive them. They can burn or freeze, can smash 
one against the rocks at the foot of a cliff, or can kill the 
body tissues by an invasion of the germs of disease. 

To these hazards of the primitive world, civilization has 
added its dangers. As man gets away from nature the 
chances of long life diminish; the industrial worker does not 
attain the average age of the farmer. The natural environ¬ 
ment of man’s origin favors his survival more than the 
artificial one which he has built up. Powers of destruction 
lurk in both, however, and to all of the environmental 
hazards must be added the hereditary taints and other 
personal faults which stand in the way of normal develop¬ 
ment. The forces of an enemy can thus be regarded as 
responsible for all the maladies suffered by man. 

Protective Powers.—A condition of health implies the avoid¬ 
ance or surmounting of these obstacles. Man has a pro- 


20 


THE FOUNDATION OF HEALTH 


tective faculty with which to overcome them, and into this 
many factors enter. Ferments and other substances dis¬ 
solved in the body fluids tend to destroy those germs and 
germ products which gain admittance. Few would have 
gained admittance, for the body’s structural arrangement is 
such that the parts subject to attack are the parts least 
exposed. A tissue which is injured tends to grow and repair 
itself, and surviving organs do the work of parts which are 
lost. These shielding and compensating powers have been 
given the name vital resistance. The trained intelligence is 
also a protective force, when it supplements and guides our 
vital resistance. 

Natural Resistance.—The resistive capacity is largely an 
inheritance. Structure and growing properties of tissue, 
certain instincts for self-preservation, and to a degree the 
substances which react against germs, all develop naturally. 
They are handed down from those who went before us. 
How the ancestral line built up this resistance is a question. 
Some would have it that as obstacles were encountered our 
progenitors acquired the power to overcome them and that 
they passed this power on to their descendants. Others 
argue that through vagaries of heredity some few chanced 
to be resistant, while untoward attacks killed off or checked 
the breeding of all others, so that only those with the greater 
resistance now have descendants. The first argument reads: 
Survival requirement-lability to overcome->transmissible trait, 
and the second just the reverse: Transmissible trait^ability 
to overcome^survival. Most of the evidence supports the 
latter view (selective survival), and does not suggest a likeli¬ 
hood that characteristics acquired due to environment can 
be passed on to offspring. 

Acquired Resistance.—Resistant factors for the protection 
of the individual himself are certainly acquired, to the extent 
at least of a tremendous increase over what is inherited. 
Types of intelligence are acquired which protect better than 
the inherited instincts. In order to overcome certain infec¬ 
tions, protective ferment must be increased enormously 
over what was naturally present. An inherited quality 
which provides for much of this increase in resistive power is 
referred to as overrepair of injured tissue. 


THE PROBLEM OF HEALTH AND DISEASE 21 


Most tissues repair themselves by the building of new tissue 
at the point injured. They build a great excess over the 
amount destroyed. If the tough layers of skin are worn from 
the hands, the repair is an excess of this tough skin, or a 
callous. Repair of broken bone is effected by a thick deposit 
of bony substance about the point of fracture; later the useless 
bony excess is gradually absorbed. Similarly, if the germ of 
scarlet fever attacks the substance protecting the tissues from 



Fig 1.—Overrepair. Bone, several days after fracture. 


it, that substance is replaced and reaches such excess that 
this variety of germ is overcome and cannot ever gain a 
second foothold. 

When sufficiently resisted, therefore, a hostile attack leads 
to further increase in the resistance. The popular practice 
of carelessly overtaxing the functions of the body as a means 
to forcing up the resistance—spoken of as hardening, or as 
“growing more like a weed than a hothouse plant”—is not 
unsound in principle. It is better though, to know where 










22 


THE FOUNDATION OF HEALTH 


the limit of endurance lies than to chance it, for permanent 
or fatal harm is done when the tissues suffer so greatly that 
they cannot repair themselves. 

Toleration Limit.—The utmost limit of resistance, beyond 
which there is no control over an attack of disease, is spoken 
of as the limit of tolerance, or toleration limit to that disease. 
Such limits vary so widely among individuals that the same 
sort of abuse might further increase one’s resistance but 
break down another’s. It is this which precludes universal 
application of any set code of health rules. Natives can 
endure the tropical sun bareheaded, but only by wearing a 
protecting helmet can the visitor from temperate zones ward 
off sunstroke. The limit to most forms of natural resistance 
varies among individuals, and that to acquired resistance 
still more. It is usually possible, however, to make a work¬ 
able estimate of the amount of abuse which a body could 
stand. 

The toleration limit to some antagonistic forces shows 
itself only by the signs of an approaching breakdown. It is 
often the prodromal symptoms, wdiich precede the regularly 
defined course of a disease, that first put people on their 
guard. By understanding these it is sometimes possible to 
check or abort the disease in its incipient stage, or if not, to 
avert some of its consequences. The earliest sign of a con¬ 
tagious disease, for instance, marks the time for isolation 
from other susceptible people. 

Specificity of Resistance.—The powers within the body 
which protect from one particular disease are collectively 
termed a specific resistance to it. The resistance to scarlet 
fever above mentioned, with which the patient had been 
feebly endowed at the start and which multiplied so greatly 
as he recuperated, resists only this one disease. A specific 
resistance to many of the infectious diseases is abundantly 
acquired on recovery, and repetition of the attack becomes 
unlikely or impossible. Such resistance can be acquired only 
through an exposure of the tissue to action of the respective 
germ or of its products; in some fortunate instances this can 
be brought about otherwise than through an attack of the 
illness. 


THE PROBLEM OF HEALTH AND DISEASE 


23 


Other types of resistance are not limited to particular 
ailments and are termed general resistance. A healthy tissue 
is more resistant to many diseases than an injured one. 
Proper feeding, exercise, and temperance improve the func¬ 
tioning power of tissue and increase its general resistance; 
the reverse is the case with improper feeding, fatigue and 
dissipation. Many rules of hygiene are designed for the 
control of such general factors as these. 

Production of Disease.—Health continues so long as the 
resistive powers of the body rise above the capacity of any 
destructive agents present. These agents are harmless if 
they do not exceed the body’s toleration limit to them. The 
campaign for health becomes a strife to subordinate the 
antagonistic powers; it is not always desirable to wipe them 
out, for the same powers may be useful. One does not go 
barefoot because shoes produce corns; instead the shoe is so 
fitted that its evils are within the control of the foot’s resist¬ 
ance. Only the agent which is sufficiently powerful to 
break the resistance, disturb some function, and do injury, 
produces disease. 

Causative Agents.—Before detailing such functional dis¬ 
turbances, we might briefly survey and systematize the list 
of injurious agents. For present purposes, it will suffice to 
classify these into three groups, according to whether they 
are biological, physical, or personal. First, there are the 
living parasites, some of them animals, some plants and 
some bacteria. Second, there are the agents which injure 
the tissues mechanically, chemically, or by temperature 
extremes. Finally, there are upsets in the tissue economy 
from within. 

Parasitism.—The first of the three groups requires the most 
explanation, for to many people germs are hazy and indefinite 
creatures. Parasites are organisms which attack living 
matter; from it they get their nourishment, and its life they 
thereby destroy. Their attack is not with any vicious intent, 
but because of an unfortunate defect which hinders the assim¬ 
ilation of other food than fresh tissue juices. All three of 
the kinds of parasites mentioned include many forms which 
can be fed from human tissues, though some of these show 
preference for the tissue of other animals. 


24 


THE FOUNDATION OF HEALTH 


Typically the unchecked course of a parasitic disease would 
run somewhat as follows: The germs find a pathway to 
some tissue on which they can live, and to grow there they 
kill and dissolve the tissue for food. The tissue is gradually 
thrown out of function; the patient dies if the function is one 
necessary to life, as is that of the heart valves. While grow¬ 
ing on the tissue, some germs would excrete into the blood 
stream a soluble toxin which is carried to and poisons other 
tissues. Action of toxin on nervous tissue leads often to 
paralysis or death. 



a be 


Fig. 2. —Microscopical parasites, a, Animal; b, bacterial; c, plant. 

Vegetable Parasites Parasites of the first two varieties 
are tiny plants and animals, usually complicated in structure. 
Many varieties of either can live, feed, and multiply in one 
or another of the human tissues. The plants parasitic to 
man are all fungi. Many of them attack the skin, and many 
the lung or other deep tissue. Among them are included 
yeasts (blastomycetes), molds (hyphomycetes), and other fungi. 
Most authorities speak of bacteria also as fungi ( schizomy - 
cetes ) but for convenience we will regard them separately. 
When the bacteria are excluded, parasitism for human tissue 
is distributed much less widely through the plant than the 
animal kingdom. 

Animal Parasites. —Four different phyla of the animal 
kingdom contain forms parasitic to man. Among the arthro¬ 
pods are mites and insects, the parasitic insects including 
lice, bugs, fleas, flies and mosquitoes. These attack most 
commonly the skin itself, or the deeper tissues through the 
skin. Other animal parasites are worms, of which the 
majority attack the intestine; these are of two phyla, consist- 


THE PROBLEM OF HEALTH AND DISEASE 25 


ing respectively of round and flat worms. The latter include 
leaf shaped {flukes) and tape shaped {tapeworms) forms. 
Many varieties of single-celled animals {protozoa) are para¬ 
sitic; some are found in the blood and others in the intestine. 

A group of long spiral forms {spirochcetes), either protozoal 
or closely allied to the protozoa, has many parasitic members. 
In apparently close relationship with these are the filterable 
parasites {filterable virus; ultramicroscopic virus) . The latter 
cannot as a rule be seen, even with the highest powered mi¬ 
croscope. Some of them pass through a stage of existence in 
which they do reach microscopic dimensions; various shapes 
are assumed, among them the long spiral. Of all the para¬ 
sites, those of this variety alone can be carried with the 
fluids containing them through a fine pored filter. We 
recognize the diseases caused and we know that the patient’s 
blood has the invisible parasite in it, for this blood can trans¬ 
mit the disease to others, but we sometimes can only guess 
at the nature of the parasite. Most of the parasites of this 
group cause general systemic infections. 

Bacteria.—Bacterial infections are the most frequently 
encountered of all parasitic diseases. The bacteria constitute 
an enormous group of living beings, leaning toward the plant 
but not falling clearly into either of the main biological 
kingdoms, as ordinarily defined. They are small and simply 
formed, measuring about 2 TTroo' of an inch across, and taking 
the form of a sphere {coccus), a rod {bacillus), or a spiral 
{spirillum)^ There are conditions under which they assume 
irregular shapes. 

The simple forms break in two after perhaps fifteen or 
twenty minutes’ growth, each of the two parts then growing 
and dividing similarly; in this way they reproduce. In some 
cases there is only one division and in some cases many before 
the newly formed individuals separate from one another. The 
rods, which always divide crosswise, can thus form into pairs 
or chains. Some of the spheres divide off in different direc¬ 
tions, which can group them into clumps as well as into pairs 
or chains. The pair, chain, or clump is not the organism, 
however, but a group of distinct and functionally independent 
organisms. 



26 


THE FOUNDATION OF HEALTH 


Habitat and Culture— Bacteria are numerous, as a rule, 
wherever animals or plants could live. They are found chiefly 
near the surface of the land. Dust, and likewise whatever 
dust can reach, usually harbors them. Innumerable billions 
could be obtained from ordinary foods, water and milk, or 
from people’s mouths and intestines. Yet, due to minute 
size, their presence is appreciable only to technical observers. 
Not only are bacteria for the most part harmless, but in 
many instances they are of great service to man. Fertility 
of the soil, many industries, and even public sanitation plants, 
depend greatly on bacterial activity. 



Fig. 3.—Bacterial cultures. 


As food for their growth, most bacteria absorb water 
containing animal or vegetable matter in solution. Labora¬ 
tory workers feed them with a broth, made from partially 
digested animal tissue. A solution of commercial peptone 
and meat extract (culture bouillon) is sterilized in cotton 
plugged test-tubes, and to this broth the bacteria under 
observation are inserted with a sterilized wire. The pre¬ 
cautions are to keep out dust, contaminated with other 
bacteria. The bacteria in the broth absorb the food dissolved 
there and reproduce rapidly, until in a few hours they have 
produced a cloudiness or other visible evidence of growth. 
This is the bacterial culture. For convenience the broth may 
be soaked up into a mass of gelatin or of a seaweed jelly 
(agar-agar), the solids being melted into the broth by heat. 
When the mass cools, there is produced a fine sponge of 





THE PROBLEM OF HEALTH AND DISEASE 


27 


gelatin or agar-agar filled with the broth, on the flat, solid 
surface of which the bacteria may be grown. 

Pathogenicity .—Comparatively few kinds of bacteria have 
the capacity for parasitism. Instead of feeding on dead 
matter alone, these excrete a poison which kills the tissue and 
converts it into food for themselves. They are called 
pathogenic. Life on dead matter gradually reduces their 
power to kill tissue, while life on the living matter gradually 
increases this potency. Germs are accordingly most danger¬ 
ous when carried directly from an infected to a healthy per¬ 
son. Their power of destroying life is termed virulence, the 
highly virulent germs destroying very readily. 

Some of the pathogenic bacteria, in addition to killing 
the tissue for food, excrete a soluble toxin. This is dissemi¬ 
nated through the blood stream and destroys tissues other 
than the one infected. One of the bacteria which is not 
parasitic at all causes disease and death by excreting a poison¬ 
ous toxin into foodstuffs. 

Germicidal Influences .—Not only is it the adaptation to a 
new sort of food that diminishes the pathogenicity of a germ 
when removed from the tissues of a patient. Many of the 
forces in nature prove actively destructive to them. Some 
of the pathogenic bacteria can live only at body temperature, 
and are killed by variations of a few degrees from this. 
Others suffer from the action of light; light retards the growth 
of the germ of tuberculosis, for instance, and exposure to 
sunlight soon kills it. Oxygen prevents the growth of some 
germs, such as that of tetanus, and they cannot grow in the 
air; many other bacteria require a considerable supply of 
oxygen in order to live. A few of the bacteria escape these 
harmful influences by passing into a spore stage, having 
nothing to do with reproduction and serving only to keep 
them alive amid adverse surroundings. A hygienic signifi¬ 
cance of the bactericidal forces in nature will appear from 
later chapters. 

Antiseptics.—Germs can often be controlled through ex¬ 
posure to agents which kill living matter, such as chemical 
antiseptics and a boiling temperature. Formalin, compound 
cresol solution, or carbolic acid are used to disinfect contami- 


28 


THE FOUNDATION OF HEALTH 


nated discharges from the body. These agents are about as 
destructive to tissue as to germs, but only the germs are 
exposed. It is also possible to prepare a strength of the 
antiseptic which will destroy germs, but not such tissues as 
are more resistant to it than the germs are. 

Tincture of iodine is widely used to kill bacteria about the 
skin, though it is somewhat injurious to the tissue as well. 
Iodine may be used to kill the bacteria in a dirty wound, for 
the tissue repair remedies any destruction of tissue. Tissue 
already inflamed has too much bacterial growth to be entirely 
killed off and the tissue might gain less than it would lose in 
recuperative power. For application to the body’s external 
membranes, a 10 or 15 per cent solution of argyrol in water 
is effective. Boric acid solution is often used for copious 
washes or irrigations; a saturated or half-saturated solution 
has hardly any destructive effect on the tissue, and to a 
degree it does destroy germs. 

When using any antiseptic on the body, the effect on the 
tissue as well as on the germ must be thought of. Anti¬ 
septics all destroy tissue, unless so weak as to be within the 
body’s toleration limit to them. 

Accidents.—The antiseptics would appear with other 
poisonous chemicals in the second group of producers of dis¬ 
ease, as above classified. Little need be said of this group 
as a whole. The causation of wounds and frostbite is familiar 
to everyone. Mechanical and chemical injury results, as a 
rule, from accident. Accidents of childhood occur because 
the child’s mind is not yet an efficient protector, and because 
the discipline by its elders is loose. Accidents occur indus¬ 
trially because the workman’s care of himself is hampered 
by carelessness, fatigue, or alcoholism, and sometimes because 
of an unfitness of light, clothing, or working space. Safety- 
first propaganda, temperance, and proper working conditions 
are the preventives. 

Upsets of Tissue Economy.—The final group of injurious 
factors, those classified above as upsets of the tissue economy 
from within, can best be taken up in connection with the 
respective organic functions. There are such faults as 
hereditary deformities which render the functions defective. 


THE PROBLEM OF HEALTH AND DISEASE 29 


It is not to be inferred that all inherent shortcomings are 
in the nature of disease; the reference is only to those that 
bring about a definite malady. Healthy and properly func¬ 
tioning organs would be stronger in one person than in 
another. 

An inherently normal function can be worn by excessive 
activity into a condition of disease; the organ becomes 
strained. Disturbance may also result from depriving a 
tissue of supplies it needs for its proper functioning; malnu¬ 
trition ensues. 

Defective traits can best be defined when we discuss hered¬ 
ity, and strains, nutritional defects, etc., will be considered 
together with the functions with which they interfere. Such 
faults within ourselves can produce disease just as can 
antagonistic forces in the environment. 

Prevention and Cure.— By forethought it is possible to assure 
the harmlessness of many powers of disease. Action based 
on such forethought is preventive medicine. It consists either 
in excluding from the body an antagonist, or in so raising 
the body’s resistance as to make the attack harmless. Pre¬ 
ventive medicine may be contrasted with curative medicine 
in that the former strives for the continuance of health and 
the latter for a reacquisition of lost health. Curative medi¬ 
cine follows the same fundamental principle as preventive. 
Disease results from partial destruction of the body’s vital 
and resistive forces, and the restoration of this broken resist¬ 
ance constitutes its treatment. 

In a few diseases the germs are best destroyed by medicinal 
preparations, but more commonly the dependence is placed 
on the resistive substances in the patient himself. The 
patient goes to bed and waits for his tissues to overcome the 
antagonist. The usual error of the unskilled consists in 
doing too much, and particularly in upsetting the physiologic 
processes with medicines. Modern medicine makes compara¬ 
tively little use of drugs. The useful medicament is only 
that which produces in the tissue a specific and needed 
activity. Curative measures are for the most part entrusted 
to the physician and therefore assume less importance, in 
this study, than the preventive. 


30 


THE FOUNDATION OF HEALTH 


Health Perspective.— Problems both of prophylaxis and 
treatment entail the consideration of just how body functions 
are or might be affected. A true perspective of the problem of 
health is based on an understanding, first, of what the body’s 
functions are like when at their best; second, of what obstruc¬ 
tive powers might tend to interfere; third, of how far the 
body can be counted on normally to resist such powers; 
and finally, of what measures might so diminish the obstruc¬ 
tions or so increase the resistance that the functioning tissue 
can overcome them. Most of the succeeding chapters will 
follow this scheme of presentation, and consider in order the 
main functions of the body. 

Reading. * 

General, Hough and Sedgwick, Chapters XVI and XXX. 

Nature and Disease, Brend, Chapter II. 

The Problem of Health, J. F. Williams, Chapter II. 

Resistance to Unfavorable Environment, Sedgwick, Chapter 
IV. 

Parasitic Antagonists of Man, Chandler, Chapter I. 

Bacteria and Their Relationship to Disease, Jordan, 
Chapters II and VII. 

Hereditary Determinants of Health, Rapeer, Chapter III. 


* See bibliography for titles and publishers of books. 


CHAPTER II. 


FUNCTIONS OF THE SKIN. 

The Body’s Envelope.— The skin and mucous membranes 
serve as an envelope to enclose and support deeper tissues, 
and to protect them from physical or parasitic injury. The 
skin and its appendages are chiefly responsible for an attrac¬ 
tive appearance. The elimination of any excessive body 
heat is also accomplished by this outermost tissue. Here, 
too, nerve endings take note of the environment, by various 
sensations such as touch, temperature sense, and pain. 

Deep Skin.— The skin consists structurally of two layers, 
an outer or scarf skin ( epidermis ), and a true or deep skin 
{derma). While fused together into one coating, the two 
are distinct in that they consist of different kinds of cells. 
Cells are the tiny units of construction which make up the 
body. They measure in most cases less than toVo of an 
inch across, and differ in shape and material according to 
the sort of tissue which they compose. Most cells have a 
nucleus, well defined from the rest of the cell, and having a 
distinctive purpose which will be discussed later. 

The cells of the deep skin are long, slender fibers or strands, 
which interlace and fuse into a tough fibrous tissue {connective 
tissue). On the strength of this fibrous layer the enclosed 
tissues depend for such support as the envelope affords. 
When its continuity is broken by a wound, fibers develop in 
excess to bridge over the defect. This overgrowth is the 
scar; the formation of a scar would not follow an injury to 
the outer skin alone, but only injury to deep skin or other 
fibrous tissue. Among the fibers which lie closest to the 
outer skin are innumerable fine bloodvessels and nerve 
endings. The ridges to be seen in the palms and soles are 
caused by particularly vascular and sensitive elevations of 
the deep skin. 



32 


THE FOUNDATION OF HEALTH 


Outer Skin.—The cells of the outer or scarf skin («epithelial 
cells) are irregular and variable in form and arrangement, 
somewhat comparable to the broken rock built into a mac¬ 
adam road except that the individual cells fit and are cemented 
together. Those next to the true skin have a tall, cylindrical 
form. Outward from these are many layers of cells, with 



the different dimensions more nearly equal. They are the 
reproductive or germinal cells of the outer skin, and they 
are continually in a process of growth and division. As new 
cells form they force the older ones outward toward the 
surface, and press them flatter and flatter. The very much 
flattened cells become tough and horny. Those at the surface 
are quite thin and scaly, and are gradually rubbed off. 
















FUNCTIONS OF THE SKIN 


33 


Hair and Scalp.—Hairs grow from sacs ( follicles ) of outer 
skin, which dip down into the deep skin. For the larger 
hairs, the sacs dip through the skin into the coat of fatty 
tissue beneath. The germinal cells at the bottom of the 
sac form a root, from which the solid shaft of hair grows 
outward through the sac’s mouth. The nourishment of the 
germinal cells, and therefore the growth of hair, depends on 
the blood circulation. The circulation of the scalp is im¬ 
proved by regular shampoo or by deep and prolonged brush¬ 
ing. Intensive stimulation by washes and ointments is not 
desirable for ordinary use, but is employed to combat certain 
diseases of the scalp. 

The hair shaft is dead matter, and nothing done to it 
affects the vitality of the hair. Singeing has no other effect 
than that of shortening the hair. Curling by heat tends to 
burn the shaft and make it brittle, but the new hair which 
grows later is unaffected. Chemical dyes and bleaches color 
only the dead shaft, as illustrated by the unpleasant contrasts 
caused by the newly growing hair with its own color. These 
substances do no harm to living tissues, except in the case 
of dyes containing lead or certain other chemicals, which are 
absorbed into scalp as well as hair and may cause dermatitis 
or systemic poisoning. 

Complexion.—The skin derives its color from the blood 
supply and from the deposit in its outer epithelial layers of 
pigment. Freckle and tan creams whiten the skin by killing 
and peeling off the pigmented cells, and a skin so whitened 
becomes even more susceptible to tanning or freckling if 
reexposed to sun or wind. The use of these creams often 
inflames the skin a little, and in still more cases it insidiously 
harshens the texture. The color due to circulation of blood 
in the skin is improved by regular massage or the occasional 
application of hot followed by cold wet cloths. 

A substitution of rouge for the natural coloring has become 
more fashionable, perhaps, than attractive. Some prepara¬ 
tions of rouge contain a mercuric salt which in time can react 
harmfully. Certain preparations for softening and thus 
“beautifying” the skin similarly contain poisonous quanti¬ 
ties of a lead salt. Use of face powder and of the ordinary 


34 


THE FOUNDATION OF HEALTH 


toilet preparations other than those mentioned does not 
interfere with the health of the skin. Cold cream tends to 



Epidermis 


Derma 




Unde.rl.ying 

IS FAT 


Fig. 5.—Follicle and glands. 


keep the skin from drying out and thus improves it, as 
cellular growth is not at its best with insufficient moisture. 





FUNCTIONS OF THE SKIN . 35 

Claims for some ointments that they supply nourishment as 
well are baseless, for while certain drugs can be absorbed 
from the outer surface of the skin, nutritious matter cannot. 

Oily Secretion.—The moisture and nourishment required 
for healthful growth of the germinal cells are absorbed from 
the underlying bloodvessels in the deep skin. A natural 
secretion of oil coats over the surface to prevent too rapid 
drying. Additional greasing may be needed in cold and 
dry weather, if chapping and cracking are to be avoided. 
Many think that petrolatum is unsuited for use on the face, 
because of a supposed stimulation of hairy growth, but this 
is doubtful. 

The oil glands (sebaceous glands ) are sacs which lie in the 
deep skin and extend sometimes into the fatty tissue beneath; 
they empty into the hair sacs. All oil pores have hairs grow¬ 
ing from them, though many of the hairs are so small as to 
escape notice. These glands absorb material from about 
them and convert it into oil, which accumulates in their 
cavities and then passes out along the shafts of hair. Glands 
(. Lat .: glam , an acorn ) are tissue nodules of various sorts, and 
usually are secreting organs. 

Cleansing of Skin.—Moisture retained by the oily film 
softens the skin and favors the rubbing off of dead scales and 
dirt. The oil naturally secreted is hardly enough to provide 
the degree of cleanliness to which civilized people have accus¬ 
tomed themselves, but efficient cleansing can be accomplished 
by additional greasing and a rub. Vegetable oils are some¬ 
times so used, or on the face cold cream. Water and soap 
clean the skin more thoroughly, because soap combines with 
the skin’s oil as well as with the water, and a greasy layer of 
dirt is removed more completely than by a mere rub. 

The complexion remains less soft under frequent washing 
than it would through use of the cold cream method, for 
washing exposes the skin more to atmospheric drying. 
Inflammation of the skin (dermatitis) in many instances 
persists obstinately until washing with water is stopped and 
the skin protected by an oil. The average skin withstands 
the harsh effect of soap and water, though its surface perhaps 
becomes somewhat shinier and harder. 


36 


• THE FOUNDATION OF HEALTH 


Bathing.—In rare instances an oil rub is preferable to the 
bath with water. Bath itch and winter itch, in the causation 
of which the drying out of the skin plays a great part, sometimes 
cannot be controlled except by a substitution of the oil rub 
for bathing. The water bath also chills the skin more, and 
delicate babies are given the oiling in preference. With 
these exceptions, the bath with water has become a universal 
institution among refined people and a characteristic of 
their refinement. 

The substitution of a daily bath for the weekly one of a 
generation ago is beneficial, but less for cleanliness than for 
circulatory exercise. Warm baths relax the vessels of the 
skin and produce a blush, while cold baths contract them and 
lead to blanching. If the heart and general circulation are 
active, the skin that has been blanched by a cold bath reacts 
with a blush; this stimulation of vascular contraction and 
relaxation is the chief purpose of the morning plunge. Old 
people and those with circulatory disorders might not stand 
well the strain of this practice. The vessels of a skin already 
blanched by chilling should be first dilated by a warm bath 
or by friction or exercise, before the cold bath can be of 
benefit. 

Sweat.—In the elimination of excessive body heat, the 
general circulatory system cooperates with the skin; the 
body when overheated sends much of its blood into the skin 
to be cooled off. The skin throws off the heat through an 
evaporation of sweat and other means to be taken up in a 
later chapter. Sweat must absorb heat to vaporize, and for 
this it uses in part the heat of the body. This is its important 
service to the body. 

The sweat also carries waste matter to the surface, the 
amount varying with the amount of such waste matter in 
the body fluids, but this elimination through the skin is 
insignificant as compared with that through other organs. 
The sweat gland does not pick up the waste matter by a selec¬ 
tive process, as does the kidney; it merely fails to filter out 
the waste from the fluids it draws on. The sweat gland 
(see Fig. 5) is a long, slender tube, the inner end of which 
appears under the microscope as if wound into a ball; into 


FUNCTIONS OF THE SKIN 


37 


this inner part of the gland surrounding moisture passes, 
and from it the moisture is secreted as sweat. 

Disorder of the Glands.—The sweat glands are less subject 
to disease than are the oil glands. Excessive functioning, 
due to hot weather or too much clothing, sometimes inflames 
them, and leads to the itching and redness known as heat 
rash or prickly heat. Children and the obese tend more than 
others to suffer from this. The itching is relieved by any of 
several dusting powders put up for the purpose, and to a 
degree by ordinary talcum powder. The liberal use of talcum 
powder and the wearing of lighter clothing lessens the like¬ 
lihood of a development of prickly heat. 

The oil glands are subject to a greater number of disorders, 
because of their larger mouths and the presence of hairs. 
Several disfigurations of the complexion may result. Scaling 
cells are shed along the walls of the hair sacs as elsewhere, and 
mix with the oily secretion. If the oil is sluggishly secreted, 
the accumulation of scales and dirt thickens it to a semisolid 
plug, which blocks up the pore. Dirt and other dark material 
colors it at the surface and gives the name blackheads 
{comedones). A passage to the surface now requires the 
mechanical aid of massage or squeezing. A blocked-in mass 
of sebaceous material is sometimes infected and becomes pus. 

Marked changes in the skin with enlargement of the pores 
occurs during adolescence, and at this time the affliction with 
blackheads and pimples is most common. At this age also, 
many persons have too oily or too dry a scalp. As maturity 
advances, these conditions tend to disappear; little can be 
done to hasten their disappearance except cleanliness and 
the general hygienic care of the skin. 

Dandruff.—Dandruff is a shedding from the scalp of dried 
scales of skin, due to a disorder of the oil glands. The con¬ 
dition appears to be mildly infectious, though there is no 
clear evidence as to what parasite causes it. Transmission 
is thought to occur by brush and comb, so the use of these 
articles in common with persons who have dandruff should 
be avoided. In occasional cases, the disease attacks areas 
of skin away from the scalp; the resulting lesion is ill-defined, 
reddened, and slightly itchy. Home treatment of dandruff 


38 


THE FOUNDATION OF HEALTH 


is not likely to prove successful. Pronounced cases are best 
put in medical hands if they do not yield to the general 
hygienic care of the scalp. The excessive dryness and scaling 
is counteracted by the rubbing in of a grease or oil, such as 
petrolatum or castor oil. 

Infection of Pores.—Bacteria present in the dirt on the skin 
often infect the oil pores and cause folliculitis. The common 
form is so mild as to be objectionable only because disfiguring, 
though severe cases of acute folliculitis do occur. Ordinary 
pimples ( acne vulgaris) seem to be caused by an infection of 
the oil pores by a rod-shaped germ specific to this disease 
(acne bacillus), in combination with the ordinary pus germs 
present. The pus bacteria are spheres or cocci, the more 
dangerous types of them developing into chains (streptococci). 



a b c 

Fig. 6.—Parasites of a, itch; b, pus; c, ringworm. 


They are resisted by the pus cells from the blood (to be dis¬ 
cussed later), which are capable of engulfing and digesting 
them. Pus consists principally of the bacteria, the debris 
of tissue destroyed, pus cells, and water. 

Boils. —If a pore is infected by pus bacteria of high viru¬ 
lence, and especially if this pore is wounded by an ingrowing 
hair, the infection passes through the wall of the sac into the 
surrounding tissue. The result is a boil (furuncle). Pus 
forms all about the hair and oil sac, which loosens as the 
surrounding tissue is destroyed and eventually comes out as 
the core of the boil. This leaves a cavity which is later filled 
in by healthy growing tissue. 

Surgical procedure shortens the process and makes it less 
painful. Hot, wet, applications relieve the pain somewhat, 
but they may spread the infection to other pores. This 


FUNCTIONS OF THE SKIN 


39 


secondary folliculitis does not as a rule develop into more 
boils, as the walls of those pores are not injured. It some¬ 
times occurs that an infection makes its way into a number of 
nearby pores and causes multiple boils. 

Carbuncle.—A group of boils is not necessarily a carbuncle, 
though some speak of it as such. The carbuncle is an infec¬ 
tion similar to the boil, but spreading beneath the skin and 
infecting from beneath the hair sacs. Living skin bridges 
over much of the infective matter, and keeps it from finding 
its way out. Carbuncles continue to extend and in many 
cases result fatally. The skin should be widely opened up 
by a surgeon and the infection treated from its under surface. 
This does not apply equally to multiple boils, which differ 
in that they do not extend beneath the skin. 

Impetigo Contagiosa.—Impetigo contagiosa is a commonly 
seen pus infection of the skin, usually of children; for children 
it is highly contagious. It spreads broadly but is quite 
superficial. The lesion begins with a slight itching and 
reddening; there follows a little blistering and then the 
suppuration. The area involved is sometimes so large as 
to give an angry appearance out of all proportion with the 
severity of the lesion. The deep skin is not involved and 
the more superficial infected layers are replaced spontane¬ 
ously within a few weeks by the growth of healthy cells. 

Frequent washing with soap keeps crusts from sealing over 
the lesion and permits the discharge to drain away freely. 
A favorable reaction may be expected from the application 
of 5 per cent ammoniated mercury ointment. This ointment 
may be too harsh for the tender skin of babies, and should 
not be used on them without a physician’s order. A pus 
forming abrasion, or any other open sore which suppurates, 
is also likely to yield to this ointment. 

Ringworm.—The minor pus infections just described, and 
many parasitic lesions of other types, are to a large degree 
preventable by cleanliness of the skin. Dirt becomes con¬ 
taminated with certain plant and animal parasites as well as 
with bacteria. The ringworms {tineas) are caused by plants 
which grow in threads among the cells of the outer skin. The 
moist skin between the toes is commonly attacked by some 


40 


THE FOUNDATION OF HEALTH 


of the fungi of ringworm, and from there the infection is con¬ 
veyed by the fingers to other parts of the body. So long as 
the affection remains confined to the skin between the toes, 
people think of it less as a parasitic lesion than a simple ero¬ 
sion with itching. The lesion begins as an itching pimple 
and extends into a broad, irregularly shaped patch with 
sharply defined borders. Between the toes it takes on a 
whitish, macerated appearance, or elsewhere a pink and 
slightly raised one. Itching continues to be a pronounced 
characteristic. 

The parasite is slowly killed and the lesion healed by any 
of several irritant chemicals, but there may be recurrences. 
A fairly effective ointment is a mixture of 2 gm. of salicylic 
acid and 4 of benzoic acid to 30 of petrolatum. This should 
be applied at bedtime for several nights. It irritates the 
tissue and should not be used for too many consecutive nights 
without allowing the skin an intervening week for recovery. 
Another remedy which is frequently successful is tincture of 
iodine, swabbed on at bedtime. 

Bromidrosis.— The development of ringworm fungi and other 
parasites about the feet is facilitated by the excessive moisture 
which collects, due to the wearing of closed shoes, especially 
patent leather. The infection adds a bad odor to the exces¬ 
sive sweating; this bad-odored sweating is termed bromidrosis. 
The odor is avoided by scrupulous cleanliness, and the lesions 
cured by a destruction of the parasite. Excessive sweating 
is prevented by the use of better ventilated footwear. Sandals 
would be ideal, weather permitting, but the average foot 
remains healthy in a shoe. 

The Itch.— The itch mite (sarcoptes scabiei) is an animal 
parasite which burrows into the skin and causes itch ( scabies ). 
Small itching elevations or blisters appear at the spots where 
the mites have burrowed in. The parasite prefers a soft and 
moist area of skin, such as that between the fingers, but it 
may attack anywhere and a body become covered with the 
lesions. Cleanliness is a preventive, but the cleanest of 
people sometimes are infected. The parasite is killed by 
sulphur; a thorough scrub taken daily and followed by the 
application of sulphur ointment soon disposes of it. The 


FUNCTIONS OF THE SKIN 


41 


use of sulphur has greatly reduced the prevalence of the itch, 
though in many quarters it is still a common disease. School 
children and older students often pay little heed to itchy 
pimples about the hands, which in reality are nests of these 
mites. 

Lice. —Among the insects parasitic to human beings are 
some kinds of lice. The body louse (Pediculus vestimenti ), 
familiarly referred to by war veterans as the “cootie,” lives 
in the seams of cotton or woolen underwear and migrates to 
attack the nearby skin. Sterilization of the clothes and a 
bath rids the infested person of body lice. 



Fig. 7.—Lice, a, Of head; b, nit; c, pubic. 


The head louse (Pediculus capitis), which lives among and 
attaches its eggs (nits) to the hair shafts of the scalp, has the 
identical appearance of the body louse. It is destroyed by 
soaking the hair over night in petroleum or kerosene; the 
oil is washed out the next morning and the hair rinsed with 
dilute vinegar to dissolve the nits. 

The crab-louse (Phthirius pubis) infests usually the hairs 
about the pubic region. Treatment consists in the close 
clipping of the hair and an application of diluted mercurial 
ointment. The kerosene or diluted mercurial ointment 
should be used with caution as it may inflame the skin, espe¬ 
cially that of young or other tender-skinned persons; kerosene 
may be diluted with an equal part of olive oil, or the oint¬ 
ment with petrolatum. 


42 


THE FOUNDATION OF HEALTH 


Insect-borne Disease.— The bite of parasitic insects is often 
the means by which general infections get past the surface 
barrier of the body. The intact skin wards off such infections 
very effectively; unlike the surface membranes, it permits 
their entrance only through injured spots. The bite of 
blood-sucking insects is one such avenue. The germs of 
several diseases can attack the tissues of an insect as well as 
of man; the insect infects itself from a patient and some 
time later transmits its infection to a healthy person. Less 
commonly the transmitting insect does not itself become 
infected, but simply draws the contaminated blood from a 
patient and reinoculates it in another person. 

Appropriate measures for the extermination of the insects 
are the best protection against these infections. Body lice 
transmit typhus fever and possibly other diseases, rat fleas 
bubonic plague, and a species of tick Rocky Mountain spotted 
fever. In Africa some forms of sleeping sickness are trans¬ 
mitted through the bite of certain flies ( tse-tse flies). Our 
house-fly transports germs, but cannot introduce them 
through the skin. The worst of the disease-bearing insects 
in this country are certain species of the mosquito. 

Mosquito Bite.— The mosquitoes subject to infection with 
the germ of malaria all belong to the genus Anopheles. 
Another mosquito is subject to infection with the germ of 
yellow fever, and probably the same one with that of dengue. 
As the males do not bite, it is only the females that infect 
themselves, and later pass their infection on to healthy per¬ 
sons. In the zones where these diseases prevail health is 
assured only by the destruction of the offending type of 
mosquito. 

Drainage of swamps helps to destroy the breeding ground 
of the malaria mosquito, or under some conditions a helpful 
measure is the planting of top minnows which feed on the 
larvae. The mosquito which spreads the other diseases men¬ 
tioned breeds more about the house and yard, and its breed¬ 
ing place is in such water as collects in old cans, etc. A 
film of oil over water prevents the breeding of mosquitoes 
by plugging the breathing pores of the larvae. Until the 
mosquito growth can be brought under control screens are 


FUNCTIONS OF THE SKIN 


43 


depended on, especially the screening of patients whose infec¬ 
tions would otherwise be broadcast by the mosquitoes. 

Dog Bite.— Other infections enter through abrasions in the 
skin not made by insects. The most formidable are tetanus, 
syphilis, rabies and anthrax. The first two will be discussed 
in other connections. The germ of rabies can attack the 
brain, salivary glands and other tissues of any mammalian, 
from one to another of which it is transmitted through the 
bite. Pet dogs are not most susceptible, but their close rela¬ 
tionship with man renders them most dangerous to him. 
The disease in the dog may reveal itself by the animal’s queer 
and furious dashing about or, more quietly, by an appear¬ 
ance of ordinary sickness and irritability. In a late stage the 
animal goes into convulsions and paralyses. The throat 
muscles are conspicuously involved, and swallowing becomes 
so painful that the thought of it drives even a very thirsty 
dog from water; hence the synonym hydrophobia, meaning 
fear of water. 

The safety of a person who encounters a mad dog demands 
simply that he stand aside several feet and out of the way. 
Rabid dogs attack only those who obstruct them; they do 
not avoid, but neither do they pursue. Public safety demands 
the killing of dogs known to be infected, and further that sus¬ 
ceptible animals be not allowed to pass body fluids along to 
one another. As the germ is transmitted only through the 
saliva, the compulsory muzzling of all dogs at large always 
proves effective in stamping out the disease. 

Anthrax.— Anthrax can infect through the skin where 
scratched raw by contaminated hairs from infected animals, 
usually cattle or horses from the Orient. Shaving brushes 
and other articles have harbored spores of the germ for long 
periods, though most cases of human infection have been 
among men w T ho work with hides. At the abraded and 
infected spot there develops most commonly a blister which 
later breaks down into a blackish slough and is surrounded 
by inflammatous hardening of the tissue; the worst cases 
have a marked puffiness which resolves into extensive slough¬ 
ing. Fever and other constitutional symptoms accompany 
the lesion, and in many cases death ensues. Anthrax infec- 


44 


THE FOUNDATION OF HEALTH 


tion from sheep enters more often through the membrane of 
the lung by inhalation of the spores. Infection has rarely 
occurred through the membrane of the digestive tract. 

Active preventive measures are almost entirely in the 
hands of the public health authorities. They consist in a 
supervision and disinfection of animal products from sus¬ 
picious sources. The discharge is highly infective, but trans¬ 
mission from man to man by spread of the discharge is not 
common. 

Felon.— Pus infection enters through any sort of break in 
the skin. A hang-nail infection may result in an abscess or 
felon about or beneath the nail. Surgical treatment often is 
required for the cure of such infections. Avoidance is by 
protection of the skin from cracking, by the keeping clean 
of a crack which does occur, or by a drop of tincture of 
iodine to kill any germs before inflammation begins. 

Nails develop from a shiny layer of cells (,stratum lucidum) 
between the growing cells and the more superficial flattened 
cells of the outer skin. The outermost layers of cells tend to 
adhere to the growing nail at its upper margin, and are 
pulled and torn by the nail’s growth. Unless these layers 
are loosened occasionally and pushed back, cracks or hang¬ 
nails develop; the pus infections may follow. The dirt 
which collects about the finger-nails is prolifically supplied 
with pus germs; it causes infection not only about the nails 
themselves, but wherever else the skin may be scratched 
raw. 

Raw Surfaces. —The avoidance of infection is the most 
important element in the treatment of small raw spots. 
Any dirt or foreign matter is first washed out with water or 
boric acid solution. Tincture of iodine should be painted 
over once, but this is not to be done repeatedly, as continued 
application would retard the repair of tissue. The sore is 
then protected from further bacterial contamination by a 
dressing and bandage of plain sterile gauze; this dressing 
need be changed only as frequently as any pus formation 
might demand. Petrolatum on the gauze prevents its adher¬ 
ence to the wound; this makes less painful the change of 
dressings and protects the growth of new skin. In the pro- 


FUNCTIONS OF THE SKIN 


45 


cess of healing the raw area is first bridged over by an exten¬ 
sion from its edges of rapidly multiplying germinal cells. 
These cells come to form a delicate pinkish film over the 
surface, which then thickens gradually into normal skin as 
flat cell and horny layers develop. 

The control of infection becomes secondary only if hemor¬ 
rhage is dangerously profuse. In most types of wound the 
bleeding is best checked by packing with sterile gauze, and 
direct pressure over this. An unsterilized cloth may have to 
be used instead if the bleeding endangers life. 

Bruises. —Bruises, which discolor but do not break the skin, 
are treated chiefly for the relief of pain and control of dis¬ 
coloration. A heavy blow is followed by bleeding into the 
tissues round about, and it is the disintegration product of 
this blood which disfigures the area. The black eye is an 
example. Cold applications immediately after the blow tend 
to check the bleeding and lessen the amount of discoloration. 
During the succeeding days occasional hot, wet applications 
hasten the absorption of the blood products. Some “beauty 
specialists” can expertly paint over and hide black eyes. 
Bruises elsewhere than about the face cause little concern, 
unless painful; hot or cold dressings afford some relief from 
resulting pain. 

Pressure of Shoes.— Unhygienic footwear causes certain 
types of mechanical injury. Tight shoes produce their worst 
effects on the skin by an interference with the circulation. 
The pressure irritates the skin and reduces its blood supply; 
this leads to the growth of corns. There is reason to suspect 
that parasitic fungi might play a part in producing some 
kinds of corns, but the evidence is insufficient for a definite 
assertion. The corns disappear when all pressure is avoided. 
They can be removed by the widely sold salicylic acid corn 
cures, but tend to recur if the pressure of the shoe is con¬ 
tinued. If a corn is to be trimmed the surrounding skin and 
the knife should first be well cleaned; otherwise a cut too 
deep may lead to painful infection. 

Ingrowing toe-nails are deformities brought about by the 
pressure of short or tight shoes or of torn shoe linings. They 
dig into the skin and lead to painful inflammation; suppurat- 


46 


THE FOUNDATION OF HEALTH 


ing infection often follows. Proper fitting of the shoes, and 
the practice of cutting toe-nails straight across instead of 
rounded, tend to prevent the digging of nails into the flesh. 
The cure of pronounced cases often requires surgery. 

Burns.— Burns have been cured by every imaginable vari¬ 
ety of treatment. Baking soda has been a favorite home 
remedy, both dusted on and applied wet. Sunburns are 
sometimes dusted over with dry soda. Wet compresses of 
soda, if applied immediately, relieve the pain of small burns 
and reduce the liability of their blistering. Another method 
of treatment is the greasing over of the burned surface. 
Carron oil, a mixture of linseed oil and lime water, has 
served very widely as a liniment for the treatment of burns. 
As a precaution against infection, the burned part should be 
kept as clean as possible. 

The very severe burn, or any of second or third degree 
that involves a large area of the skin, needs medical atten¬ 
tion. Burns are recognized as of three degrees. They some¬ 
times redden only (first degree), sometimes blister (second 
degree) and sometimes destroy true skin tissue (third degree). 
If one-third of the total surface of the skin is badly burned 
a fatal outcome is probable. Death may come very shortly 
from the shock, or it may ensue after many days from a 
complicating inflammation of the kidney. Products of the 
burned tissue are absorbed by the blood and inflame the 
kidneys while being eliminated. 

Frostbite.— Frostbite whitens and destroys sensation in the 
frozen area. The application of snow is said by patients to 
afford immediate relief, while the tissue thaws; the part is 
afterward rubbed lightly and gradually warmed to room 
temperature. A frostbitten foot or hand is kept slightly 
elevated after it has thawed. There follows later an inflam¬ 
matory stage of swelling and redness, and at this period the 
management is as varied as for burns. 

After a mild frostbite the tissues promptly heal, though as 
a rule their circulation remains poor, as many of the tiny 
bloodvessels are lost. The same area becomes less resistant 
to subsequent freezing. Frostbite of a grade severe enough 
to shut off bloodvessels of any size results in a sloughing away 
of part of the tissue. 


FUNCTIONS OF THE SKIN 


47 


Chemical Injury.— The corrosion of tissue by chemicals is 
not greatly different from that by mechanical or thermal 
agency. First aid consists in washing off part of the chemical 
and neutralization of the rest. Most acids could be neutral¬ 
ized by soda solution, or alkalis by dilute vinegar. Carbolic 
acid is removed by alcohol or a fat. After elimination of 
the chemical the treatment of the lesion is the same as that 
already described for raw surfaces. 

Chemicals in a concentration too weak to corrode may 
initiate a milder inflammation (<chemical dermatitis). The 
avoidance of further exposure to a chemical known to be 
injurious is likely to be all that is required for a cure. Unfor¬ 
tunately, the chemical at fault often is not recognized. Many 
chemicals, as well as agents other than chemicals, produce 
very similarly appearing cases of dermatitis; the determina¬ 
tion of actual cause usually requires medical attention. 
Formalin and other antiseptic preparations have often 
inflamed the skin, some individuals being more susceptible 
than others. 

Poison Ivy. —Injurious substances which often attack the 
skin of campers and others in the woods are the resinous saps 
of the poison ivy and poison oak plants. The prevention of 
such poisoning is only through the careful avoidance of the 
two plants. The leaves of the poison ivy form into clusters 
of three, and are thereby distinguished from the harmless 
creepers with five leaves. The poison oak shrub has a broad 
leaf resembling that of an oak tree. Either of the two harm¬ 
ful saps can be removed with alcohol or by thorough scrub¬ 
bing with soap immediately after exposure; they are tena¬ 
cious, and could be merely spread over the skin by a careless 
rub or wash. 

This form of dermatitis begins with a burning sensation, 
which by the following day develops into a redness of the 
part, and later into swelling and blistering. The lesions 
often assume an angry appearance. After inflammation has 
set in the results of treatment are uncertain. Several prepa¬ 
rations have been used with a degree of success, one of which 
is a 1 per cent solution of permanganate of potash, painted 
over the lesion. Usually the malady must run its accustomed 


48 


THE FOUNDATION OF HEALTH 


course of about two weeks. Care must be taken meantime 
to avoid the transfer to healthy skin of any of the exudate 
from the lesion. 

Cancer.— Some of the types of new-growths (neoplasms) 
form another group of skin lesions. The worst of these 
tumors is the uncontrollable and spreading overgrowth of 
epithelial tissue called cancer. An important causative fac¬ 
tor is the continual or often-repeated injury to which areas 
of skin are sometimes subjected; the simple irritation of the 
lip, kept up by a rough pipestem, is a much cited example. 
It is not always after mechanical injury, however, that can¬ 
cerous nodules appear. 

In the early stage the cancer can be removed, but not after 
it has had sufficient opportunity for extension. The preven¬ 
tion consists in the avoidance of persistent open sores, or if 
a cancerous nodule develops in the early removal of that 
nodule with such nearby tissue as the surgeon deems neces¬ 
sary. It is not until early adulthood is past that such tumors 
become a real menace. 

Warts.— Benign tumors also occur in the skin. Unlike the 
cancer, they remain localized to the original place of devel¬ 
opment and have no serious consequences. Warts are benign 
tumors of the skin, being overgrowths of the epithelial cells 
at the affected point. Though unsightly, they do no harm 
and eventually disappear. Many weird remedies have favor¬ 
ably impressed the users, as their application happened to 
be made shortly before the warts disappeared. Immediate 
cure is by destruction of the wart and all the surrounding 
tissue; this can be done by the action of strong acid, of 
heat, or of freezing, but can hardly be done safely by the 
inexpert. 

Moles.— A mole ( ncevus ) in the skin is usually benign. 
Spots of different sorts have been called moles; a common 
type is the swelling due to a local dilatation of small blood¬ 
vessels. The pigmented mole is less harmless than other 
types in that it sometimes becomes cancerous, especially if 
irritated. Pigmented moles should be removed by a surgeon 
or else left strictly alone and protected from mechanical 
irritation. General consideration will be given the tumors 


FUNCTIONS OF THE SKIN 


49 


in a later chapter. The skin is only one of many tissues which 
may be involved. 

Danger in Skin Lesions.— As mild skin troubles are so often 
cared for at home, we have in this chapter been concerned 
with curative as well as preventive medicine. Regardless of 
appearances, the patient should in all cases consider care¬ 
fully whether medical attention can safely be dispensed with. 
No unrecognized lesion should long be allowed to persist, 
for some that are dangerous simulate mildness. Cancer of 
the skin appears first as a simple little lump. This and 
other lesions of the skin need expert attention and need it 
early. Some types of inflammation affect the skin’s resist¬ 
ance as time goes on, and make recovery progressively 
harder. A process which involves the deep skin continues 
to produce scar tissue, and while this limits the spread of 
the disease it may also interfere with the treatment. 

Reading. * 

General , Pyle, Section by Fox. 

The Hair, Pusey, Chapters XI and XII. 

Care of Hair and Nails, Winslow, Chapter III. 

Baths and Bathing, Bowers, Chapters IV, V and VI. 

Types of Skin Inflammation, Cornell, Section on Skin. 

Treatment of Some Skin Diseases, Cabot, Chapter XVII. 

Animal Parasites of the Skin, Chandler, Chapter XX. 

* See bibliography for titles and publishers of books. 


4 


CHAPTER III. 

THE MEMBRANOUS COVERING. 


Mucous Membrane.— The convenient conception of a com¬ 
plete envelopment of the body tissues by skin and mucous 
membrane is possible if we regard the cavities within the 
stomach, bowel, bladder, etc., to be outside the body. A 
biscuit would enter the body proper when absorbed through 
the membrane into the blood stream, rather than when 
swallowed. A marble, if swallowed, would not enter the 
body at all. 

The surfaces which border on the body cavities and are 
least exposed to the environment are those covered by mem¬ 
brane, as the more exposed are covered by skin. There are 
two expanses of the membrane. The larger lines the respi¬ 
ratory and digestive tracts, and sends extensions from the 
throat through the Eustachian tube to the middle ear, from 
the nose through the tear duct to the eye’s surface and 
through ducts to the sinuses about the facial skull. The 
other expanse of membrane lines the genital and urinary 
organs. 

Function— The function of these surface membranes cor¬ 
responds roughly with that of the skin, though most require¬ 
ments are less severe as the surfaces are less exposed. All 
functions listed as of the skin are to some extent those also 
of the membrane. A function of the membrane which the 
skin shares to only an insignificant degree is that of passing 
materials from the outside to the body fluids and vice versa. 
Dissolved foods pass through the membrane of the bowel, 
and oxygen and carbon dioxide through that of the lung. 

Structure —The structure of the mucous membrane like¬ 
wise corresponds roughly with that of the skin. A superficial 
coat of epithelial cells rests on a deeper fibrous support. The 


THE MEMBRANOUS COVERING 


51 


epithelium is continuous with that of the skin. Generally 
speaking, the parts adjacent to or not far removed from the 
skin have many layers of epithelial cells, whereas the parts 
considerably removed have but a single layer. The single 
layer of cells is better suited for passing substances through 
into the body fluids. In the fibrous tissue beneath the 
epithelial cells are bloodvessels and nerves. Glands of epithe¬ 
lial cells dip through at places into or through the fibrous 
layer; these secrete various fluids which we shall have occa¬ 
sion to consider later. 

Mucus.— One of the glandular fluids is the rather thick and 
sticky phlegm, or mucus, which gives the membrane its name. 
The mucus protects the membrane from atmospheric condi¬ 
tions and also from dust and infection. Germs and dust are 
collected and held mechanically by this sticky fluid, which 
in its passage carries them on away from the membrane. 
Too frequent use of antiseptic washes about the mouth, nose, 
and throat tends to do harm in that it keeps the mucus 
cleaned away. Unless there is foul breath or other sign of 
disease, such washes have no hygienic purpose at all. 

Why Teeth Decay.— Teeth are outgrowths from the mucous 
membrane. The cause of dental decay, and the body’s power 
of resisting it, are but partly understood. Evidence accu¬ 
mulated from different sources suggests that many factors 
contribute. Inherent factors enter in, including such placing 
of the teeth in the gums as to permit or preclude lodgments 
of food between them. The diseases of infancy are thought 
to affect the buds which are to develop into teeth, and thus 
to predetermine the degree of dental health. Soft foods favor 
the development of cavities, whereas teeth that chew tough 
food acquire strength and remain solid. Investigators hold 
that dietary deficiency of mineral salts and vitamins is partly 
responsible for decay. Acids formed in the ordinary decom¬ 
position of surrounding food particles are held to dissolve out 
the tooth substance, as are the acid products of streptococci, 
which have been thought by some to invade the tooth in 
advance of the cavity formation. 

Decay of teeth is one of the misfortunes of civilization. 
The uncivilized Esquimos are comparatively free from it, 


52 


THE FOUNDATION OF HEALTH 


and American Indians largely so, while nearly all American 
and European white people are afflicted. Most of the con¬ 
ditions above listed as favorable to decay are likewise con¬ 
ditions of civilization. Civilized people are more likely to 
have survived the diseases of babyhood. Furthermore, the 
refined diner has turned from most of the hard foods, and 
the rest he chews insufficiently to avoid noise. Soft-cooked 
foods have lost much of their vitamins and easily decompose 
about the teeth. The relationship between, or the relative 
importance of, these several factors which combine to destroy 
the teeth of civilized man, is not clear. 

Care of the Teeth.— Means of prevention are obscured by 
the confusion as to cause. Authorities usually agree that the 
teeth are preserved by frequent brushing, at least once daily 
at bedtime. After teeth are brushed the glands proceed to 
coat them over with fresh clean mucus; the secretion about 
them would otherwise become mixed thickly with food mat¬ 
ter. If left undisturbed for a period longer than twenty-four 
hours the mucous films harbor also considerable bacterial 
growth, with resulting acid products that attack the teeth. 
Food particles not reached by the brush are best removed 
with dental floss. 

The brushing of teeth cannot be considered all sufficient as 
a prophylactic against caries. The clean tooth never decays 
—with the onset of decay it is no longer considered clean— 
but more than a brush is required to maintain its cleanliness. 
Proper diet, and the other influences which favor soundness 
of the teeth, are no less important. 

Tartar and Pyorrhea. —If the teeth are not carefully attended 
to, calcium is the more likely to deposit as tartar. The tartar 
then harbors bacteria. It is well to have the dentist remove 
such deposits at regular intervals, the frequency of the treat¬ 
ments depending on the rapidity of the accumulation. Some 
teeth need dental cleaning every six months, and others not 
oftener than once every few years. Tartar formation is often 
associated with a mild inflammation of the gums (gingivitis) 
which causes the gums to redden and to retract from the 
teeth. 

A more severe inflammation of the gums is the suppurative 


THE MEMBRANOUS COVERING 


53 


pyorrhea. Pyorrheal abscesses develop between the teeth 
and gums and discharge pus into the mouth. This gives the 
breath a disagreeable odor, and is among the very common 
causes for bad breath. If untreated the discharge tends 
often to become worse, the gums to deform and the teeth to 
loosen. The condition may improve only with prolonged 
dental treatment. 

Dental Repair Work. —Decaying cavities {caries) in teeth 
enlarge with progressively increasing rapidity, and should by 
all means be filled early. While the outer layer, or enamel, 
of the tooth is resistant to moisture and bacterial decay, 
the deeper layer, or dentin, is not. Moisture diffuses into 
exposed dentin, and prepares the ground for infection; cavi¬ 
ties then enlarge rapidly. Repair of the tooth before the 
dentin is greatly involved means a much smaller filling. 

The milk teeth, as well as the permanent, stand in need of 
dental fillings if carious, though not necessarily of such dur¬ 
able fillings. During the few years of existence their function 
is important. Without good teeth the child cannot chew 
comfortably and acquires a habit of bolting its food. The 
milk teeth play a part also in the development of the jaws; 
on this is dependent the regularity of the permanent set. 

Root Abscesses.— A common sequel of neglected caries is 
the so-called root abscess , which develops in the jaw about 
the root of a tooth. This follows a destruction of the pulp, 
and need be looked for ordinarily only about dead teeth. 
The pulp of a tooth is the bundle of bloodvessels and nerves 
which extends into the central cavity of the dentin, to supply 
nourishment and sensation. When this matter has been 
destroyed the tooth is no longer sensitive to pain, has no 
blood supply and is spoken of as dead. 

In the process of its decay the infected pulp ferments and 
forms gas, the pressure of which forces infective material 
through the tip of the root to the socket in the jaw. This is 
the common origin of root abscesses. Discomfort is not 
always caused; only when sufficient pus or gas accumulates 
to cause considerable pressure in the abscess cavity does 
aching and swelling occur. 


54 


THE FOUNDATION OF HEALTH 


Cancer.— There is occasionally a much more serious sequel 
to caries. Sores kept raw by broken teeth have developed 
into cancer; wounding of the surface is not dangerous, but 
this continued irritation of an open wound is. Cancer can 
develop in the mucous membrane just as it can in the skin, 
and the area involved is not infrequently the mouth. 

Other parts of the membrane are quite as susceptible. 
Cancer of the stomach or gall-bladder results from irritation 
within these organs, and the membrane which lines the 
uterus is a frequent site. The pain and other symptoms 
suggestive of stomach trouble, if associated with pallor and 
loss of weight in people of advanced age, or a bad-odored 
and bloody uterine discharge, are warnings of the danger of 
cancer. The management of the condition, as before pointed 
out, consists in early surgical attention. 

Membrane as a Barrier.— In protective power for the 
deeper tissues the mucous membranes fall far short of the 
skin. In view of its function of passing needed substances 
from the outside to the tissues, it might be expected to pass 
in also harmful materials. As will be discussed in a later 
chapter, there are poisonous gases which pass the membrane 
of the lung, and poisonous solutions that of the bowel. What 
is perhaps worse, the germs of many infectious diseases pass 
readily through the membrane. Some of them infect and 
inflame the membrane and involve secondarily the deeper 
tissues; the germs which attack the membrane are more 
infective for deep tissues than are those which attack the 
skin. Others pass through the membrane without inflaming 
it at all, whether through minute abrasions or intact mem¬ 
brane is not clear. The main point is that some infective 
agents can get to susceptible tissue if they reach certain 
parts of the membrane, from which our protection demands 
that they be kept away. 

Sources of Infection.— Intelligent avoidance of this class of 
germs depends on the source from which they come and on 
the possibility of blocking the routes by which they approach. 
The primary source or breeding ground is practically always 
someone else’s tissues which have previously been infected. 
Inanimate objects can be entirely disregarded, as none of 


THE MEMBRANOUS COVERING 


55 


them breed the germs of serious illness; they may, however, 
and often do convey the germs. The previously infected indi¬ 
vidual is likely to be, but is not necessarily, a patient with 
the disease. In many cases he is not ill, even though the germ 
does multiply about his tissues. Such people are termed 
carriers of disease. 

Persons are spoken of as carriers only if the germs breed 
about them; carrying is not in this sense the same as trans¬ 
porting. Carriers of disease may be the patients before they 
show symptoms or convalescents who continue to harbor 
the germs after all symptoms have gone. In addition there 
are individuals who never develop enough symptoms of a 
disease for diagnosis, but who more or less permanently 
harbor its germs. Carriers of the diseases of man are, as a 
rule, human beings, though not always. One type of germ 
causing tuberculosis in man is bred in cattle. Certain other 
germs attack lower animals and also mdn, though many of 
them are not those which enter through the mucous mem¬ 
brane. 

It is convenient to consider the routes of transmission from 
these primary sources to the healthy membrane in groups, 
according to the part of the membrane attacked. One group 
would be those which lead to the upper or lower respira¬ 
tory membrane; that is, to the membrane about the nose and 
throat, lungs or bronchial tubes. Another group is of routes 
to the membrane of the eye, and still another is of those to 
the genital membrane. A last group is of routes leading to the 
membrane of the digestive tract, particularly that of the 
small or large intestine. 

Respiratory Invaders.—Routes of the first group are fol¬ 
lowed by the germs of some general infections, as well as by 
those of respiratory and throat infections. Germs of small¬ 
pox, cerebro-spinal meningitis, infantile paralysis and other 
diseases not of the respiratory tract, enter the body through 
this part of the membrane. 

These routes are usually short and very direct. Spray 
coughed out, attendants’ hands, and objects handled are 
contaminated from respiratory secretions or other infective 
exudates from the infected person. The infective matter is 


THE FOUNDATION OF HEALTH 


56 

conveyed thereby to the nose or mouth of some healthy person 
present, who consequently becomes infected. If transported 
for any distance before reaching the second party the germs 
will have lost their infective power. Their numbers are 
reduced by scattering and perhaps their vitality is lost, 
through the influence of the distance factor. At all events, 
the healthy membrane most endangered is that of a person 
in the presence of the infected one. 

This rule has its exceptions. Infective bacilli from a 
patient with tuberculosis persist for a while in dark and moist 
corners, and might infect others who afterward go there. 
Germs of scarlet fever and diphtheria grow in milk, and are 
transmitted through the milk supply. Very largely, however, 
the infection through the respiratory membrane involves 
close proximity of the infecting person with the one infected; 
this is known as contact infection. Diseases so transmitted 
are called contagious, and are the most readily communicable 
of diseases. 

Contact Infection.—The reliable protection against respira¬ 
tory or other contagious diseases lies in distance. Public- 
health authorities post communicable disease placards to 
keep those in health away, or else they remove the patients to 
isolation hospitals. The fact that he is ill isolates the patient 
to a considerable degree. The great dissemination of germs 
by him is before his illness puts him in bed, or after he leaves 
the sick-room; it is this that must be guarded against. 

Those who are susceptible and have knowingly been in 
contact with a case should be watched until it is known that 
they are not developing the disease, that is, through the 
period of incubation for that disease. The incubation period 
is the number of days after infection before the symptoms 
appear. At the end of this period, the suspect is either 
obviously ill or is not a danger. The period is a few days for 
scarlet fever or diphtheria, or about a fortnight for smallpox, 
chicken pox, measles or whooping-cough. 

A greater danger is from convalescents, who continue for 
an unfortunately variable period to carry the infections. 
They are isolated until all apparent lesions heal, and for an 
arbitrary period which is ordinarily enough for riddance of 


THE MEMBRANOUS COVERING 


57 


the germs. Those who carry the germs longer than usual be¬ 
come healthy carriers, and these are often the greatest menace. 

Infection at Large.—The proportion of apparently well 
persons who carry germs of disease, while problematic, is 
certainly not inconsiderable. In the case of diphtheria, it is 
found that during the season when this disease prevails a 
considerable percentage of persons carry the germs. Healthy 
carriers of diphtheria and meningitis can be detected, though 
carriers of many other contagious diseases cannot. The 
detectable carriers could not possibly be weeded out of an 
entire population, and the difficulty is still greater as regards 
the others. The segregation of all infective foci in the com¬ 
munity is therefore out of the question. 

A second difficulty is that some infections of this group are 
so widespread that a separation between the infected and 
the healthy would not be practicable. The community 
could not afford to have in isolation all cases with chronic 
tonsillitis, or all with a pneumococcus or tubercle bacillus 
infection. Cases and carriers will continue to remain at large, 
because their condition either is not diagnosed or does not 
justify isolation. 

Protective Habits.—The impracticability of a complete 
segregation of all cases throws our dependence on such 
hygienic measures as tend to keep their infective secretions 
from the respiratory membrane of healthy persons. If people 
can be prevailed on to keep their mouths clean, to cough or 
sneeze only into handkerchiefs, and not to spit, the danger of 
a spread of any infection they might carry is lessened. 
Frequent washing of the hands and an avoidance of the use 
of towels and cups in common with others, are a help. 

Carefully fitted gauze masks are the only really effective 
precaution for keeping any contamination in spray, dust, 
or objects handled, from reaching the nose or mouth. Such 
masks consist of several thicknesses of gauze so tied as to 
cover the lower part of the face and filter all inhaled air. 
Their practical use is limited to the protection of susceptible 
persons who care for patients with contagious disease. The 
mask should not be removed until the wearer is away from 
infected persons, and until he has washed his hands. Except 


58 


THE FOUNDATION OF HEALTH 


in the presence of a known case of contagious disease, most 
people would prefer taking an ordinary risk of infection to 
wearing the mask. 

Diseases of this Group.—In their effect on the respiratory 
membrane, the diseases which enter the tissues by this route 
may be regarded as of three sorts. The first are the diseases 
which inflame the membrane mildly or not at all, but which 
pass through to and seriously inflame deeper tissues; the 
eruptive diseases are examples. The second are the respira¬ 
tory diseases proper; they inflame the parts of the membrane 
in the lungs or in the passages leading thereto, and disturb the 
breathing or the aeration of the blood. More will be said 
of these sorts when we consider respectively the diseases 
of childhood and the function of the respiratory tract. 

The third sort are those which inflame the membrane of 
the throat or mouth and do not directly affect the respira¬ 
tory function. A sensation of soreness develops and other 
signs according to the nature of the infection. Intense 
soreness suggests an involvement of tissues underlying the 
membrane also. Acute sore throat can never be neglected 
with safety, at all events not until diphtheria has been ruled 
out as a possible cause. 

The Throat.—Persons who do not always have available 
the services of a physician will do well to familiarize them¬ 
selves with the appearance of the throat. Even where the 
amateur’s diagnosis of throat troubles is not reliable, it is 
far more trustworthy than the widespread tendency to trust 
to luck and wait for a sore throat to subside. Viewed from 
in front, the entire membrane of a normal mouth and throat is 
uniformly pink. The soft palate appears arched across to sepa¬ 
rate the mouth in front from the throat, or pharynx, behind. 
This arch arises from pillars, two to either side, which join 
above into the single arch. The tonsils appear as rounded 
or flat nodules of tissue low down between the two pillars. 
They are often hidden entirely, but appear when the tongue 
is pressed down with the handle of a spoon. Examination 
for sore throat is of the tonsils and the pharynx. 

Tonsillitis.—A common ailment of the throat is acute 
follicular tonsillitis. About a day after the infection has set 


THE MEMBRANOUS COVERING 


59 


in the tonsils become markedly swollen and reddened, and 
later white spots or patches may appear on them. The 
patient should be kept at rest in bed, for while the soreness 
would subside in a few days anyway there is danger that the 
germs may enter the blood stream and infect also heart- 
valves, joints, nerves, or other tissues. Such complication 
may even prove fatal. 



Aspirin has often been given for tonsillitis and sometimes 
a painting over of the tonsils with argyrol or other chemicals, 
but no medicine *or local treatment has sufficient merit to 
recommend it as a general home remedy. Cold wet cloths 
or ice-caps about the neck sometimes lessen the aching, and 
a gargle of hot water in which a little baking soda is dissolved 
leaves a fresher and cleaner sensation about the mouth. 






60 


THE FOUNDATION OF HEALTH 


Chronic tonsillitis, which results in frequently recurrent 
sore throat, is evidenced by a ragged or irregular surface of 
the tonsils and by a surrounding area of slightly increased 
redness. The great danger from the chronic, as from the 
acute, form of tonsillar infection is that other tissues may 
secondarily become involved; this will be referred to in the 
paragraphs on focal infection. 

Pharyngitis.—Simple pharyngitis most frequently accom¬ 
panies a cold in the nose or chest. Slight soreness develops, 
with a reddened and granular appearance to the back of the 
throat. The cause of colds is not yet known, and it is of 
less significance than that of their complications. A com¬ 
plicating infection by a pus germ (; pneumococcus ) changes the 
pharyngeal inflammation from a harmless to a formidable 
type. This pus infection may spread to and along the 
Eustachian tube until it reaches the middle ear, where it 
causes the severe and dangerous otitis media. Earache and 
other pronounced symptoms following a cold call for investi¬ 
gation. The slight stuffiness and impairment of hearing which 
often accompanies a cold is only an interference with the 
middle ear’s air pressure, by the swelling shut of the Eusta¬ 
chian tube. Extension to the lungs of the complicating pus 
infection results in bronchopneumonia. Typical lobar pneu¬ 
monia is also a pneumococcus infection of the lung, but not 
a complication of pharyngitis or colds. 

Diphtheria.—Diphtheria is an infection of the membrane 
by a certain bacterium {Klebs-Loffler bacillus). The inflam¬ 
mation, most often over the tonsils or pharynx, is character¬ 
ized by a whitish film of clotted fibrin from the blood seeping 
out. White patches on the tonsils may be either diphtheritic 
or due to tonsillitis; if they spread beyond the area of the 
tonsils, the probability of diphtheria is great. Medical 
treatment should be instituted as early as possible, because 
of the soluble toxin which this bacterium produces. The 
patient’s recovery is assured only if the toxin is neutralized 
by antitoxic serum before its effects are badly felt. 

Other Lesions.—Another lesion of the mucous membrane, 
known as Vincent's angina, consists in a whitish-floored 
ulcer with well-defined and reddened margins. Either mouth 


THE MEMBRANOUS COVERING 61 

or pharynx is attacked. While it does not endanger life, 
this is a troublesome and often persistent infection. It is 
treated successfully by physicians or dentists, but the treat¬ 
ment must sometimes be a long and tedious one. Mouths 
are less likely to be infected if kept clean and otherwise cared 
for. 

Canker sores are small, whitish spots in the mucous mem¬ 
brane of the mouth, to which poorly nourished persons are 
especially liable. A cure can often be brought about by 
the stimulating effect of an irritant solution such as tincture 
of iodine touched to the spot. 

Gonococcal Infections.—Another group of transmission 
routes leads to the membrane of the eye. These also are to 
be listed under contact infection. The most important 
invader of the genital membrane is that which causes gonor¬ 
rhea. This infection will be discussed in a later chapter, 
together with syphilis. Syphilis enters through an abrasion 
of either membrane or skin, and is not so likely to gain foot¬ 
hold in the intact membrane itself. 

Gonorrhea can attack also the membrane of the eye, and 
is the worst of the infections which enter through that part 
of the membrane; it may destroy the entire eye. Profuse 
pus formation in an inflamed eye suggests the probability 
of a gonorrheal infection. Any inflammation more severe 
than a simple reddening should have the attention of an 
oculist. 

Conjunctivitis.—Inflammation limited to the conjunctiva 
is spoken of as conjunctivitis ; there are several types. The 
conjunctiva is the membrane which covers the front of the 
eye, and folds back to cover the under surfaces of the lids. 
This membrane is exposed to contact infection just as the 
respiratory membrane is, and can be protected by similar 
measures. Distance from the infected person is the best 
preventive, or where that is impossible a scrupulous care to 
avoid the bringing of the fingers to the eyes. 

An inflammation which consists only of a simple redness 
extending in from the outer edge of the white of the eye is 
likely to yield to home treatment. Irrigation of the eye 
may be repeated three or four times a day, preferably by 


62 


THE FOUNDATION OF HEALTH 


passing over the membrane a stream of fluid from a bulb 
syringe. Half saturated boric acid solution is a favorite 
wash for the eye. The irrigation is sometimes preceded sev¬ 
eral minutes by a drop of 10 per cent argyrol. 

Other Eye Infections.—Redness which is most marked in a 
narrow circular band about the outer lens indicates a congestion 
of vessels supplying the accommodation muscle within the 
eyeball. This reddened circle means therefore that the dis¬ 
ease {iritis) is within the eye itself, and such a condition 
should have the specialist’s attention. Any inflammation 
about the eye which does not tend rapidly to subside also 
needs medical attention. 

Trachoma is a chronic infection which at first causes little 
discomfort and is often neglected. In its early stages it is 
diagnosed by small granulations scattered over the conjunc¬ 
tiva of the lids. As the disease progresses, the tissue becomes 
gradually deformed by extensive scar formation. Ulcer or 
other complication about the outer lens leads in an occasional 
case to blindness. Early treatment effects a cure, but very 
little can be done for the advanced case. The contagious 
element is great, and though the patient may not be uncom¬ 
fortably ill he should regard himself as a menace until the 
condition is cured and avoid careless association with others. 

The Lids.—A scaling and reddening sometimes occurs 
along the margins of the lids {blepharitis ), often with a slight 
discharge of pus. It is commonly called granular eyelids, 
a term more properly applied to trachoma. This mild 
scaling is often associated with either conjunctivitis or eye- 
strain. Greasing of the lid margin with petrolatum at bed¬ 
time will often relieve the condition; if it does not, the 
probability increases of another ailment as well, and medical 
attention should be sought. 

Styes are sometimes associated with blepharitis or other 
disturbance about the eye. Sometimes they occur inde¬ 
pendently. The stye {hordeolum) is an infection of the fol¬ 
licle about one of the eyelashes. If the lash involved is 
pulled out, the inflammation may be expected to subside. 
A series of styes, one after another, suggests additional trouble 
about the eye as a cause. 


THE MEMBRANOUS COVERING 


63 


Foreign Bodies in the Eye.—Cinders or other foreign bodies 
in the eye can often be removed by a moistened swab of 
sterile cotton, or by a clean handkerchief. Cinders are 
easily removed from the white of the eye or the membrane 
beneath the lid. The upper lid, after a little practice, can 
be everted over a match stem and its under surface exposed; 
a shallow furrow appears close to the margin, and in this the 
foreign bodies will often be found. It is unsafe for the 
inexperienced to remove a cinder from the outer lens. 
Work on the membrane over this area, which is very sensi¬ 
tive, requires skill and often a local anaesthetic. 

Antiseptics.—Mild inflammation of the membranous parts 
so far discussed reacts well to treatment with argyrol. The 
solution can be dropped in the eye, swabbed over mouth or 
throat, sprayed into the nose, etc. Unless the inflammation 
readily subsides or is recognized as one suitable for home 
care, the treatment at home is better not depended on for 
too long. 

While active infections are favorably influenced, the use 
of argyrol has greater value at home as a preventive of infec¬ 
tion. The solution is used immediately after infective 
material has reached the membrane. Argyrol is one of 
many antiseptic silver compounds which have proven bene¬ 
ficial when applied to mucous membranes. 

Intestinal Invaders.—The infective agents that attack the 
membrane of the digestive tract become harmless less rapidly 
after their removal from the body than do those already con¬ 
sidered. The danger zone is much broader, and most of the 
infected do not even come near the infecting persons. In 
this respect these germs are the greater menace. On the 
other hand, the transmission routes are much more cir¬ 
cuitous and are easier to control. The germs leave the 
patient or carrier chiefly by the bowel discharges, and cannot 
reach the digestive membranes of others unless swallowed. 
It is usually through a contamination of food or drink by 
somebody’s excreta that the infection is transmitted. Trans¬ 
mission does not readily occur through contact. 

Sanitation in America has diminished but not eliminated 
the direct mixture of body waste with water and food; in 


64 


THE FOUNDATION OF HEALTH 


some other localities it has not even diminished it. Almost 
universally in Asiatic countries, and to a less extent in Amer¬ 
ica, the fields are fertilized with human body waste; this 
waste both contaminates the foods grown and drains into 
water supplies. Carriers are more largely responsible for 
the contamination of milk and other foods in this country, and 
carelessness about disposal of bowel discharges for the con¬ 
tamination of streams. 

Diseases of this Group.—Typhoid and the paratyphoid 
fevers, cholera, and dysentery, are among the worst of the 
diseases so transmitted; the germs of dysentery attack the 
mucous membrane of the large intestine, and those of the 
others that of the small intestine. One form of dysentery is 
caused by an animal parasite (Entamoeba histolytica) and 
another by any of several closely related bacteria; both are 
characterized by a diarrhea in which mucus and blood are 
passed, accompanied by great pain locally and by general 
symptoms. In cholera there is a profuse diarrhea which 
removes much of the fluid from the tissues; this dehydration 
accounts in part for the marked prostration and other gen¬ 
eral symptoms of the disease. In typhoid fever and the 
paratyphoid fevers the intestinal are usually overshadowed 
by general symptoms, and often are entirely absent. 

Infected Meats.—In the case of a few diseases, transmission 
routes of this group are even less direct than those indicated. 
Disease can be contracted through ingestion of the flesh of 
animals which were infected before slaughter. A form of 
food poisoning, to be gone into later, consists in an infec¬ 
tion of the intestine by bacteria which had infected the 
animal and persisted in its tissues. Several of the intestinal 
worms also are transmitted along this route. 

Eggs or larvae of most of the worms enter the intestine as 
a contamination of drinking water and foods. The larvae of 
a few, however, must undergo a stage of their development in 
the flesh of lower animals; they migrate to the flesh of the 
animal after hatching from worm eggs which the animal has 
swallowed. These larvae infect man only if he eats the flesh 
containing them. 


THE MEMBRANOUS COVERING 


65 


Worms.—Infection by one of the tapeworms (Taenia solium) 
or by the trichina (Trichinella spiralis) results from the eating 
of diseased pork which had not been thoroughly cooked; other 
tapeworms enter similarly with beef or fish. Most serious 
of these is the trichina, which causes the frequently fatal 
trichiniasis. Trichina infection is kept alive in rats; the 
healthy rat is infected by eating tissue of a diseased rat. 
Hogs which eat infected rats or scraps of diseased pork acquire 
the infection; they pass it on to man. Tapeworm and 


CD 



Fig. 9. —Tapeworm. Larva in meat develops to adult in intestine. 


trichina diseases are preventable by the thorough cooking of 
doubtful meats, especially pork. The U. S. Government 
inspection of meats reduces the danger in this country, as 
does also the wide employment of cold storage; this will be 
discussed later. 

Round Worms .—Eggs of many parasitic round worms are 
transmitted through water or food from the discharges in 
which they are laid to healthy alimentary tracts, where they 
hatch. Infestation with worms is almost world-wide, and 
5 



66 


THE FOUNDATION OF HEALTH 


is particularly prevalent in warm climates where sanitation 
is poor. The custom has arisen in many places of self- 
medication with vermifuges at regular intervals, for the 
purpose of driving out any worms that chance to be present. 
This indiscriminate practice is hardly to be commended 
except where medical diagnosis is not available. Very active 
treatment under medical supervision for those found infected 
is a better practice than the mild treatment for all; examina¬ 
tion of the bowel discharges shows clearly whether or not 
eggs of worms are present. Vermifuges depend for their 
efficacy on toxic constituents, and only the highly toxic ones 
can be relied on to dislodge the more troublesome worms. 

The round worms vary in size from that of a quarter-inch 
length of hair to that of a pencil. The pinworm (Oxyuris 
mrmicularis) infects the lower rectum, chiefly of children, 
and on migration through the anal opening cause a character¬ 
istic itching. The ascaris {Ascaris lumbricoides) approxi¬ 
mates the size of a slate pencil; it produces either no symp¬ 
toms or very mild ones. The whipworm ( Trichuris trichiura) 
is a little larger than a pin; it also causes but slight symptoms, 
if any. The mild symptoms due to these latter worms are in 
the nature of a temporarily nervous disposition and some 
slight pallor. 

Hookworm .—Hookworm disease is caused by another intes¬ 
tinal round worm which migrates from the bowel discharges 
of patients; unlike the others, it does not as a rule enter 
healthy persons by the mouth but through the skin. The 
ground is contaminated by excreta of patients, and there the 
eggs hatch into larvae which soon crawl about; persons who 
walk barefooted within a few yards of the place are likely to 
step on them and become infected. Individual prophylaxis 
consists in wearing shoes or keeping away from hookworm 
localities. The disease can be stamped out by a proper 
disposal of excreta and the cure of infected persons. 

Purification of Water.—Those of the parasites which enter 
with drinking water are killed by thorough boiling. House¬ 
hold purification of water can be effected also in other ways. 
The Berkefeld and similar tap filters render bad water safe 
for drinking if sound and properly adjusted, but frequently 


THE MEMBRANOUS COVERING 


67 


they crack or work loose and then fail to remove germs. A 
handy treatment for suspicious water is with tasteless and 
harmless antiseptics, though these cannot be depended on, as 
can boiling, to destroy the eggs and cysts of animal parasites. 

Standing for half an hour with a little chlorinated lime 
dissolved in it rids water of intestinal bacteria. To the 
gallon of drinking water is added a teaspoonful of a stock 
solution, made by dissolving a teaspoonful of bleaching 
powder in a quart of water. The stock solution, or in a moist 
atmosphere the bleaching powder itself, goes stale and deteri¬ 
orates; only the freshly prepared solution made from a reason¬ 
ably fresh powder is therefore to be depended on. Tablets 
also are widely sold with directions for the chlorination of 
water. Tincture of iodine, 2 drops to the quart, has also 
been found to destroy within one-half hour the dangerous 
bacteria in contaminated water (method of Hitchens ). Nothing 
surpasses heat for reliability; boiling for a few minutes 
removes all danger. 

Safety of Foods.—Intestinal parasites are killed from most 
foods in the process of cooking; some foods have been cooked 
for this one purpose. In many regions where sanitation is 
unheard of, it is dangerous to eat uncooked salad greens; 
the latter have sometimes been soaked in mild antiseptics 
and eaten raw, but this does not rid them of animal parasites. 

Milk is the food of which bacterial contamination is most 
to be dreaded, for in milk at ordinary temperatures most 
bacteria rapidly multiply. Typhoid fever, scarlet fever, 
diphtheria, septic sore throat, and one type of tuberculosis, 
have to a considerable degree been spread in this way. The 
market milk of most American communities is unsafe, espe¬ 
cially for the feeding of babies and children. Milk from an 
unknown source is not to be trusted, and should be either 
boiled or heated to 145° F. for twenty or thirty minutes 
(■pasteurization ) before use. Pharmacies supply dairy ther¬ 
mometers. After pasteurization the milk must be kept cool; 
bacteria are reduced to a safe fraction by the heating process, 
but in a warm place would again multiply. A higher tem¬ 
perature is required for sterilization. 


68 


THE FOUNDATION OF HEALTH 


Hands and Flies.—After heating, the food or milk is safe, 
but there remains the danger of recontamination. The rich 
bacterial growth on the hands is much decreased by washing 
but never entirely removed, and a carrier gets disease germs 
mixed in with the other bacteria present. If he works in a 
kitchen, or otherwise handles foodstuffs, he passes some of 
the germs to the foods. Attendants of patients can be a 
similar menace, by handling other people’s foods. Most of 
the dangers in unpasteurized milk originate from the presence 
of carriers or sick persons in the dairies. 

The surface of the housefly transmits germs of disease 
just as do dirty hands, though to a less degree. The fly 
also has a way of vomiting up part of the material previously 
fed on; fly specks are such material. Into the sugar bowl 
can be regurgitated any excreta previously eaten by them; 
flies are filthy in their feeding habits. War on flies is a 
fundamental part of any campaign for the wiping out of 
intestinal infection. 

Reading* 

General , Cabot, Chapter IV. 

Care of the Teeth, Fisher and Fisk, Section IV, Chapter III. 

Carriers and Missed Cases of Disease, C. V. Chapin, Chap¬ 
ter II. 

Sore Throat, Cornell, Section on Nose and Throat. 

Infection Through Foods, Sedgwick, Chapters V and XII. 

Safe Water, Woodman and Norton, Chapter V. 

Intestinal Worms, Chandler, Chapter XI. 


* See bibliography for titles and publishers of books. 


CHAPTER IV. 


INFECTION AND IMMUNITY. 


Infection.—By infection is meant a parasitic invasion of 
tissue. The body’s first line of defense against this invasion 
lies in the intelligent avoidance of the germs. An attack 
by the germs is unheralded, but if their sources are known all 
possible pathways of approach can be obstructed. Some of 
the routes by which germs reach the healthy person have 
been enumerated. Parasites of the more serious ailments 
inhabit tissue only, and unless under artificial cultivation 
they die when indefinitely removed from tissue. Protection 
is through control of the routes from the infected tissue of 
one individual to the healthy tissues of another. 

Sources .—Many of man’s infecters cannot be perpetuated 
except in the tissues of man. Certain others grow in the 
tissues of lower animals, and may at any time be brought 
from these to human beings. Prophylactic measures against 
all of the animal-borne infections must be directed toward 
the susceptible animals. Bubonic plague and trichiniasis, 
for instance, affect rats primarily and are stamped out by 
the destruction of rats. 

Those of the infections which develop in the tissues of 
man alone are to be controlled by the cure of patients and 
carriers or by the effective guarding of the various routes of 
transmission from person to person. The reason health 
officers interest themselves so much more in the disposal of 
body waste than in that of garbage is that the waste from an 
infected person may transmit his infection, whereas garbage 
does not originate from any infective source and therefore is 
not of consequence in the transmission of disease. 

Physical Barriers .—Some mechanical barriers about sus¬ 
ceptible tissues form a second line of defense. Germs are 
nourished only by the tissues they can digest and absorb, 


70 


THE FOUNDATION OF HEALTH 


and the structure of the body is such that susceptible tissues 
are usually innermost. The germs which can destroy skin 
are not often the ones which can destroy the more vital 
tissues. The mucous membrane is a poorer barrier than the 
skin, so the germs which attack it endanger more gravely 
the deep tissues. Other germs can get in only if an opening 
through the body’s envelope is made for them. 

Some protection is afforded, particularly about the mem¬ 
branes and about wounds, by the outward flow of fluids. 
Secretions and excretions only occasionally destroy bacteria, 
but their outward flow regularly washes them away. Gland¬ 
ular tissues and the mucous membranes would otherwise be 
more susceptible to bacteria. Wounds are also protected 
from infection by the outward flow of fluids; a short delay 
before the binding up of small cuts does away with many 
harmful bacteria. 

Immunity.—Tissue reactions form a last line of defense, 
by which the germs that do get in may be ejected. Tissues 
produce resistive substances (immune bodies ); after coming 
into conflict with an invader they produce them very actively. 
This protective reaction is spoken of as immunity. Tissue 
fluids, by their content of ferments and other dissolved sub¬ 
stances, destroy the germs of disease and any products of 
the germs. Sometimes the tissue reacts quickly, shows 
pronounced inflammation, and proceeds within a few days 
or weeks to destroy the invaders. This is acute disease. 
The ailment is chronic when its causative forces contend 
less actively but more persistently with those of the resist¬ 
ance, and the combat drags tediously on and on. 

The character of the body’s reaction varies according to 
the nature of the infection. Certain cells of the body 
(; phagocytes ) swallow into themselves some kinds of parasites, 
and proceed to digest them with ferments. Other cells 
pour into the body fluids the immune substances which they 
form. These substances encounter the germs and their 
products in the blood stream, and there dissolve them or 
otherwise render them harmless. 

Pus Formation.—The most conspicuous body cells which 
engulf bacteria are the white cells of the blood ( leukocytes). 


INFECTION AND IMMUNITY 


71 


These cells are round and flat, are microscopic in size, and 
float freely in the blood stream. While always present in 
the blood, their number increases after the invasion of certain 
germs. They are attracted to the place of infection, where 
they draw into themselves and destroy the bacteria. The 
engulfment of bacteria does not entirely dispose of their 
poisonous properties, but by escaping as pus the white cells 
take from the body the harmful products. Drainage of 
pus from wherever it may have accumulated is a first prin¬ 
ciple of surgery. 



Fig. 10.—Pus bacteria and leukocytes. 


Focal Infection.—From the site of infections which the 
body has not as yet gotten rid of, the blood sometimes carries 
pus germs to other susceptible tissues. Invading bacteria 
may gain the complete upper hand and distribute abscesses 
throughout many parts of the body. This condition is 
called pyemia, and is one type of septicemia; the multiplica¬ 
tion of any kind of germ throughout the body fluids would be 
called septicemia. A pus infection which is better resisted 
than this might still gain a foothold in one or two of the most 
susceptible tissues. Before acutely inflamed tonsils could 
destroy the infection within them, a secondary inflammation 
of the joints or of the valves of the heart could occur. In 
these cases of acute infection, the secondary involvement is 
spoken of simply as a complication. 

Mild pus infections of years’ duration may distribute 
germs intermittently to other tissues, and lead to their 
infection. From infected tonsils, sinuses, or roots of teeth, 
where they breed, the germs are carried to joints, nerves, 
heart valves, or iris, which secondarily inflame. The result 
is rheumatism, neuritis, endocarditis, or iritis; these are 
instances of the many diseases which arise in this way. The 



72 


THE FOUNDATION OF HEALTH 


process is called focal infection, for from the original lesions 
as foci, the infection attacks tissue after tissue. The cleaning 
out of primary foci prevents the development of secondary 
foci elsewhere. Bacteria of the type usually concerned, cer¬ 
tain streptococci, are most prone to attack primarily the 
mouth and various parts of the upper respiratory tract, but 
it is not safe to harbor pus infection anywhere in the body. 

Fixed-cell Phagocytes.—The capacity for engulfment and 
destruction of bacteria belongs to cells of the fixed tissues as 
well as to those floating freely in the blood stream. Certain 
cells of the bloodvessel walls, of the spleen, of the liver and 
especially of the lymphatic tissue, have this power. Some 
cells have their greatest power of engulfment over one type of 
bacteria and others over another. Nodules of tissue (lymph 
glands) which occur here and there throughout the body are 
so connected as to filter out germs from the fluids passing 
through the lymphatic vessels. The lymphatic system of 
vessels collects tissue fluids, or lymph, from all parts of the 
body and conveys it to the large veins near the heart. It is 
likely that lymphatic tissue also produces much of the soluble 
antibody which is poured into the body fluids to combat 
germs there. 

Enlarged Glands.—Lymph glands often give evidence of 
having gathered in tubercle bacilli, which remain in them 
and die without harming the body. In other instances 
the germs prove more aggressive than the glandular tissue 
which has trapped them, and an inflammatory enlargement 
with some softening ensues. Swelling of the glands to 
either side of the neck (cervical lymphadenitis) is a common 
instance. The usual germ to cause a marked and persistent 
enlargement is the tubercle bacillus, which has entered 
through the tonsils and passed on through lymph vessels to 
the glands. This is the same organism which causes tuber¬ 
culosis of the lungs, but the glandular infection need not 
cause apprehension of a subsequent lung involvement; often 
it is by an altogether different type of the germ and the same 
type of germ might attack any of several tissues and remain 
localized there. 

Many cases of glandular enlargement offer little cause for 


INFECTION AND IMMUNITY 


73 


concern, but as other cases need surgical attention all should 
be seen by the physician. By early operation the enlarging 
glands can be completely removed, whereas cases so advanced 
that extensive softening or involvement of surrounding 
tissues has taken place, offer difficulties. Simple incision 
for drainage is preferable to spontaneous rupture, as the 
latter leaves an ugly scar. 

Tonsils.—Tonsillar and certain other lymphatic tissue 
functionates about as do the lymph glands. The tonsils in 
children are supposed to make the throat safer by entrapping 
and destroying germs there, but they normally shrink up as 
age advances and become inactive after the ninth year. Very 
often an infection exceeds the toleration limit of the tonsil; 
streptococci overcome the resistance of the tonsil much 
more often than tubercle bacilli do that of the lymph glands. 
The tonsils then lose any beneficent function they may have 
had, and become breeding places for germs. Not only does 
injury to the throat result from this, but other tissues are 
likely to be infected from this point as a focus. Furthermore, 
it is in the tonsils that carriers harbor diphtheria bacilli or 
pathogenic streptococci. 

Tonsils which in the opinion of a conservative specialist 
have lost their functional power and are given over to bac¬ 
terial breeding should be completely removed. It is true 
that the tonsils would later shrink up and tend to give less 
trouble anyway, but bacteria may continue to breed in 
small, shrunken tonsils which afford no throat symptoms at 
all. The old operation of clipping off the tonsils does not 
stop the multiplication of germs in them; it is rarely of any 
value, and its use has been practically discontinued. 

Antibodies. —Instead of engulfing and destroying the germs, 
many of the tissue cells throw out protective substances which 
remain in solution in the body fluids. These soluble de¬ 
stroyers are referred to collectively as antibodies. They 
must encounter two main factors of infection. The poisonous 
toxins which bacteria excrete are to be acted on and made 
harmless. Secondly the bacteria themselves, which are 
living and multiplying in the tissues, are to be killed and 
their bodies gotten rid of. 


74 


THE FOUNDATION OF HEALTH 


The antibodies are all specific; that is, a given antibody 
counteracts but one injurious factor of one disease. Each 
individual disease is combated by substances which are 
powerless against other diseases. Furthermore, the anti¬ 
body against a germ’s toxin does not resist the germ that had 
produced the toxin; separate antibodies are required for 
each. 

Antitoxin.—Bacterial toxins injure the tissue cells. Accord¬ 
ing to one time-honored theory (of Ehrlich) a given toxin 
attacks only those cells with constituents specifically adapted 
for combination with it. The attack injures the cell by 
destroying these specific constituents. The latter are slowly 
but excessively replaced, unless the injury has stopped cellu¬ 
lar growth, through the tendency to overrepair. They reach 
enormous proportions, and swarm from the tissues into the 
fluids, as antibody. 

Additional toxin which may enter afterward combines with 
this substance in the blood stream instead of with the same 
substance in the cells, and the cells are spared. The tissues 
are therefore protected as soon as they have reacted to the 
toxin with antibody formation. This particular antibody 
is called antitoxin. The combination of toxin and antitoxin 
resembles in some respects a simple chemical union. If 
antitoxic blood serum is put in a test-tube with some toxin, 
it renders the latter non-toxic. An antitoxin combines only 
with the one toxin which led to its formation, and does not 
resist the toxin of any other disease. 

Antitoxic Serum.—The tissues of a horse which is injected 
with toxin produce and fill the fluids with antitoxin. The 
blood serum of this immunized horse is suitably prepared and 
marketed for the medicinal effect of the antitoxin it contains. 
When such serum is injected into a patient, infected with 
bacteria producing the toxin, it relieves him of further toxic 
effect; the toxin in his system is neutralized by the antitoxin 
injected. The horse is selected because its size permits large 
quantities of the antitoxic blood to be drawn without injury. 

The injection of the horse’s antitoxic serum relieves human 
tissues by raising an immediate resistance (passive immunity ) 
to toxins in the system. The sera of greatest service to 


INFECTION AND IMMUNITY 


75 


man are those prepared to combat diphtheria and tetanus. 
To assure a cure, the diphtheria antitoxin must be injected 
as soon as symptoms become sufficient for diagnosis. 
Tetanus antitoxin should be administered without waiting 
for symptoms to develop, after any deep and dirty wound. 
Symptoms of this disease do not appear until too late for 
the assured success of the treatment. Use of these two anti¬ 
toxins ranks very high as a life-saving measure. A fatal 
outcome of the type of food poisoning called botulism can 
also be averted by the very early use of an antitoxin. 

Preventive Immunization.—The passive immunity acquired 
by the introduction of an antitoxic serum lasts only until 
that antitoxin is eliminated from the body, not longer than 
a few weeks or months. As an enduring protection against 
the development of a disease, it has no value. On the other 
hand, an immunity which lasts for many years results if the 
antitoxin be produced by the activity of the individual’s 
own tissues {active immunity) through an exposure to the 
toxin itself. Only the active immunization is satisfactory 
as a general preventive measure. 

Diphtheria toxin, rendered safe for use by mixture with 
antitoxin {toxin-antitoxin, or T. A.) is injected to the human 
body and leads in the course of several months to the pro¬ 
duction of a durable immunity. Three injections are taken 
at weekly intervals. This inoculation cannot cure the dis¬ 
ease as does an injection of antitoxin, but it prevents the 
development of an attack several months or years subse¬ 
quently. 

Toxins Other Than Bacterial.—The biological toxins with 
which human tissues may come into conflict are not only those 
of bacterial origin. There are toxins also of higher plants 
{phytotoxins) and of animals {zootoxins). The phytotoxins 
are relatively unimportant, though much technical interest 
has been attracted to toxic principles in the castor bean and 
a few other plants. The zootoxins of greatest import in 
hygiene are the venoms of snakes. Certain arthropods, fish, 
and toads also produce soluble toxins. 

Snake Venoms.—The most poisonous snakes are the cobras 
and some others of the same family, which are widely distrib- 


THE FOUNDATION OF HEALTH 


76 

uted through parts of the Orient. Some of these are con¬ 
siderably more venomous than any of the viper family. 
Three of the vipers, the rattler, the copperhead, and the 
water moccasin, are the most dangerous of the domestic 
snakes; the rattler is much more venomous than the other 
two. The widespread fear of the rattler is, however, hardly 
justified by its bite. The venom causes severe inflammation, 
but is rarely fatal except to infants and children. The sup¬ 
posed cures by the internal use of whisky occur because 
patients get well regardless of treatment. 

The venom of the rattler causes locally a marked swelling, 
pain, and discoloration, as well as pronounced prostration, 
nausea, and general discomfort. The respiratory and other 
paralyses which are characteristic of cobra poisoning do not 
associate themselves so conspicuously with the bites of 
vipers. 

Snake-bite.—First aid after snake-bite consists in an 
immediate attempt at localization and removal of the toxin. 
A bandage is wrapped tightly a short distance upward, that is 
toward the heart, from the bite; a short distance farther up 
may be placed a second, and then a third bandage. With 
a sharp knife several deep, criss-cross incisions are made 
about the point of the bite, for the escape of body fluids 
containing the venom. Irrigation of the wound, or the 
popular practice of sucking fluids from it, may be continued 
until a physician is obtained. One per cent solution of 
potassium permanganate in water is a fluid commonly recom¬ 
mended for irrigation, due to its oxidizing effect on the toxin, 
but in its absence water suffices. The bandages are removed 
after a half-hour but may be replaced if general symptoms 
follow. 

Venom which reaches the general system can be neutral¬ 
ized by antivenins, which correspond precisely with the anti¬ 
toxins. One preparation counteracts cobra venom and 
another viper venom. The antivenins are unfortunately 
scarce in the markets of this country, as snake-bite is so 
infrequent as to create little demand. 

Arthropod Stings.—Several of the arthropods have a venom¬ 
ous sting, the effect of the venom in this case being almost 


INFECTION AND IMMUNITY 77 

entirely local and comparatively mild. The stings of certain 
varieties of spiders or tarantulas, of scorpions, and of centi¬ 
pedes, have occasionally been known to cause death in some 
parts of the world. That of any species native to the United 
States produces no constitutional effects of any severity and 
is never fatal. 



CENTIPEDE 


TARANTULA 


Fig. 11. —-Venomous arthropods. 


More widespread are the stinging insects, particularly bees, 
wasps, hornets and ants. The stings of honey bees have a 
barb, which holds the sting in the wound. Extraction of the 
barb is the first step in the treatment. As most venoms of 




78 


THE FOUNDATION OF HEALTH 


this class are acid, the treatment by wet compresses of 
baking soda gives some relief and has come into common use. 

Germicidal Antibodies.—Explanation of the antibodies 
which dispose of bacteria and products of bacterial disinte¬ 
gration is more difficult than that of the antitoxins. Anti¬ 
bacterial activity and its associated clinical phenomena can 
be pictured only by rather free dependence on theory. The 
formation of antibodies to attack bacterial cells may be 
explained just as was the formation of antitoxins. Injurious 
bacterial products stimulate the tissues to elaborate anti¬ 
bodies, and after a period to throw them into the body fluids. 
This raises the active immunity against that kind of bacteria. 
The mode of action of these antibodies, however, is very 
much more complex than is the simple neutralizing action 
of the antitoxins. 

Split Protein Theory.—An ingenious hypothesis (of Vaughan), 
though apparently at variance with some of the evidence, 
relates many of the phenomena of infection and immunity 
with a poisonous disintegration product which is regarded 
to be split by antibodies from the proteins. Bacterial cells 
consist partly of proteins, organic products the nature of 
which will be discussed later. Proteins are extremely com¬ 
plicated in chemical structure, but are capable of being 
broken down by ferments into less and less complex sub¬ 
stances. The digestion of bacteria in its first stages kills 
them, and in the several succeeding stages breaks down their 
proteins into forms simple enough for elimination from 
the body. An unfortunate intermediary stage of this diges¬ 
tive process supposedly converts the protein into substances 
which in part are poisonous, though in the final stages all the 
products again become harmless. 

Infecting bacteria gradually multiply and increase the 
amount of foreign protein in the system. This protein does no 
harm for a time, but stimulates the formation of a protective 
ferment or antibody. After a certain period the ferments have 
completed their development and begin to be thrown by the 
tissues into the body fluids. Then they flood the system, and 
on combating the bacteria they are supposed to liberate 
poisonous constituents from this great accumulation of foreign 


INFECTION AND IMMUNITY 


79 


protein. Thereupon, pronounced symptoms such as prostra¬ 
tion and fever appear. In the stage before these symptoms, 
known as period of incubation, disease may not have been 
even suspected. After the symptoms appear we speak of 
the active stage of the disease. 

Vaccination.— The antibodies are essentially protective, 
and the bad effects are due not to their presence but to the 
delay of their production until the foreign substance has 
accumulated. When present before the infection, they 
immediately break up any bacteria that enter the body and 
the protein poisons do not reach a harmful concentration. 
Vaccination is the introduction of various preparations of 
germs for the purpose of forcing up the body’s content of 
such an antibody. The split protein theory is presented 
because of its simplicity; it is not essential to a conception 
of bactericidal activity, and the idea of a protein poison 
does not enter into certain other theories. 

Whatever be the explanation, there is no questioning the 
fact that the introduction into the body of certain germs, or 
their products, does provide the system with protective 
power; it excites such antibody formation that subsequent 
exposure to the same germ does not lead to the disease. A 
well-tolerated dose of the germ is introduced, and this raises 
the limit of resistance against the attack of this kind of germ. 

Bacterial Vaccines.— The commonest form of bacterial 
vaccine is a suspension of killed organisms. Some bacteria, 
even when killed or disintegrated, are sufficiently reactive 
to raise an active immunity. Vaccines have been found to 
combat effectively only a few of the bacterial diseases, how¬ 
ever, and their indiscriminate use to counteract all manner 
of infections is not justified. 

Cure of several chronic infections has been attempted 
through a building up in this way of active immunity, but 
such treatment has been disappointing and is gradually being 
abandoned. Various types of pus infection are still treated 
with vaccines by many physicians. The bacterial vaccine 
has greater value as a preventive measure. A high degree 
of protection can be raised in this way against typhoid and 
allied infections and against cholera; a much smaller degree 


80 


THE FOUNDATION OF HEALTH 


of immunity is acquired against pneumonia, plague, and a 
type of dysentery. Against other bacterial infections the 
results have been less promising. 

Typhoid Vaccine.—The vaccine used for the prevention of 
typhoid and the paratyphoid fevers has done very great 
service to man. An attack of typhoid fever would bring a 
reaction of the tissue so severe as to protect throughout life. 
Vaccination against the same fever, by its milder reaction, 
protects for two or more years absolutely and for a number 
of years to some degree. Typhoid fever might be contracted 
years after the inoculation, but it would probably be a mild 
attack. 

Infections so slight as to be tolerated by the tissues and 
not produce symptoms probably occur, and have the same 
effect as a vaccine. This may explain the supposed natural 
resistance which has sometimes characterized the inhabitants 
of regions with a high exposure hazard. Typhoid fever strikes 
down a greater proportion of strangers in such communities 
than of natives. 

Pasteur Treatment.—Parasites other than bacteria succumb 
also, in some instances, to an artificially raised active immun¬ 
ity. Material for protective inoculation against rabies is 
prepared from the ground-up spinal cords of infected rabbits. 
The unknown germ of the disease is in this tissue, a suspension 
of which is injected daily for a period of three weeks (Pasteur 
treatment). The germs given in the earlier doses are weak¬ 
ened by drying, to be better tolerated by the tissues. The 
treatment was formerly available at institutes only, but it 
has now been made possible to the family physician. 

The incubation period of rabies is so long that the treat¬ 
ment may begin several days after the infecting bite and 
still raise the resistance in time to prevent the disease. The 
saliva of rabid dogs is infective for a few days before the 
symptoms appear, so any dog which has bitten somebody 
should be watched for about ten days; if it goes mad within 
this period the bitten person takes treatment. Laboratory 
examination of tissue from the dog’s brain, for microscopic 
ovoid bodies (Negri bodies) characteristic of rabies and pos¬ 
sibly forms of the parasite itself, is also reliably diagnostic. 


INFECTION AND IMMUNITY 


81 


Smallpox Vaccination.—Protection against smallpox can 
likewise be developed after exposure to the disease. Imme¬ 
diate vaccination is urgent for all un vaccina ted persons who 
happen to come into the presence of a case of smallpox. As 
persons usually cannot tell when they are being exposed, a 
far safer procedure is to anticipate any possible exposure by 
vaccination. The germ used as vaccine differs in its produc¬ 
tion of disease from that of smallpox, but it is probably an 
attenuated type of the same biological form; at all events 
each immunizes against the other. 

The practice of vaccination originated from the discovery 
that farmers and others who had had cowpox did not contract 
smallpox. Vaccine is prepared from the semipurulent dis¬ 
charge of inoculated cowpox in heifers. In a large, shaved, 
and surgically clean area of the heifer’s abdomen, many cuts 
are made through the outer skin, and into these the infective 
material is rubbed. Six days later the matter to be used 
for vaccine is scraped from the resulting lesions; from this 
matter is prepared the market product. Strict pre¬ 
cautions are observed throughout, to prevent a contami¬ 
nation by any infective organisms other than the vaccine 
parasite. 

Bactericidal Sera.—Germicidal sera have been made to 
produce a passive immunity, but as a rule they do not have 
the curative power of antitoxic sera; against the germs them¬ 
selves a passive immunity is produced less readily than 
against their toxins. Immune serum is effective for killing 
the germs of epidemic meningitis and those of one type of 
pneumonia, but for some reason this is not the rule with 
bacterial infections. Active immunity of a germicidal 
nature is slowly raised and of great prophylactic value in the 
many instances just given, but very few of the infections 
are curable through the use of germicidal sera. 

Clear discrimination must be made between the two types 
of biologic preparations used in specific prophylaxis and ther¬ 
apy. Immune serum contains the antibodies taken from 
an immunized animal, and is injected to bring about an 
immediate, though fleeting, passive immunity. To be con¬ 
trasted with this is the active immunity, brought about by 
6 


82 


fHE FOUNDATION OF HEALTH 


the human tissues themselves under the spur of inoculated 
products of the germ. 

Chemotherapy.—Most of the animal parasites do not suc¬ 
cumb to artificially excited antibodies, though several of 
them do to certain chemicals which may be introduced to 
the body with safety. Quinine, in a concentration quite 
harmless to human tissues, destroys the protozoal parasites 
of malaria. A few grains of quinine taken daily will protect 
the tissues from any malaria germs which might enter, and this 
preventive is recommended to those who travel into malarial 
regions. Other animal parasites yield to preparations of 
arsenic, antimony, or ipecac. 

A perfectly safe chemical compound may be quite as 
germicidal as a slightly different one which is highly toxic 
to the body. Much study is now being centered on the use 
of complex chemical compounds with such combining power 
as to unite with and kill germs but not the tissues ( chemo¬ 
therapy ). 

Protein Sensitization.—Disease phenomena are produced 
by various proteins in no way associated with parasitism. 
Certain people have hives ( urticaria ) after eating a food which 
contains some particular protein. In some cases the eating 
of shellfish, in others the eating of other protein foods, causes 
hives. This condition is to be considered in the chapter on 
Nutrition. It is an individual hypersensitiveness to a par¬ 
ticular protein. The split protein theory outlined in a 
preceding paragraph was originally applied to phenomena 
obtained by the use of lifeless proteins. 

A hypersensitiveness is produced in guinea-pigs by the 
injection of such proteins as egg white, or the blood serum of 
a different species of animal. Injection of a few drops of 
horse serum would not injure a normal guinea-pig, but it 
can seriously affect one which has received even ttttt of a 
drop about ten days previously. x\fter the first injection, 
the animal might be regarded as having developed ferments 
capable of breaking down the protein, so that the second dose 
is immediately broken into poisonous form. An analogous 
condition in the human is the serum sickness which sometimes 
results from the injection of an antitoxic horse serum, ,e§p,e- 


INFECTION AND IMMUNITY 


83 


daily if serum had been administered previously. Few 
people, however, suffer from serum sickness and these few 
with only moderate discomfort. The condition has been 
serious in so few cases that an anticipation of it should never 
stand in the way of treatment with antitoxin. 

It is only in the exceptionally few individuals that hyper¬ 
sensitiveness of any sort appears; a few acquire a hypersen¬ 
sitiveness to serum or to some other protein, and a few 
others have naturally a hypersensitiveness to some food. 

Hay Fever.—Another form of natural hypersensitiveness 
in man is to certain pollens. This is an inherent trait which 
gives rise to attacks of hay fever. Symptoms result from a 
settling on the nasal mucous membrane of some pollen to 
which the individual is hypersensitive. During the period 
in which that pollen blows about, sneezing and other symp¬ 
toms resembling those of a cold continue frequently to recur. 
These symptoms could be explained as due to the irritating 
effect on the membrane of a poisonous protein product, split 
off locally by some tissue ferments peculiar to that person. 

Hay fever may result from any of several pollens. Pollens 
disseminated otherwise than by the wind do not reach the 
nostrils in appreciable quantity, and these cause the affliction 
in exceptional cases only. This rules out the possibility of 
hay fever due to roses, golden rod, and other flowering plants 
of which insects bear the pollens, though some of these are 
erroneously thought by many to be the cause of their trouble. 
Wind pollenized plants are the only real danger. An early 
spring hay fever has resulted from inhaling the pollen of trees, 
and the more prevalent late spring hay fever from inhaling 
that of grasses, particularly timothy. The very prevalent 
autumn hay fever is caused usually by the pollen of ragweeds. 

Prevention .—The cutting of grass and weeds as a means 
of prevention can be made effective only if done very exten¬ 
sively, for the pollens are voluminous and buoyant and are 
blown over great distances. Victims often seek resorts in 
the mountains, at the seaside, or in the woods, during the 
hay fever season, as being free from the plant most trouble¬ 
some in their particular case. The pollen most troublesome 
in one section of the country differs from that in another. 


84 


THE FOUNDATION OF HEALTH 


Protective inoculations of extracts from the pollens tend 
to establish temporarily a non-reactive period and to reduce 
the sensitiveness. This is not an active immunity of the sort 
established by the injections before mentioned. It avails for 
only the one season, though it may be successfully repeated 
each year. 

Reading.* 

General, H. D. Chapin, Chapter IX. 

Infection Through Surface Breaks, Sedgwick, Chapter V. 

Immunity, Jordan, Chapter VIII. 

Local and Focal Infection, Billings, Lecture I. 

Lymphatic Tissue as a Protection, Winslow, Chapter VII. 

Resistance to Parasites, Chandler, Chapter II. 

Protein Fever and Phenomena of Infection, Vaughan, 
Part III. 

Hay Fever and Allied Conditions, Harvey Lectures, 1915-16, 
Lecture by W. T. Longcope. 


* See bibliography for titles and publishers of books. 


CHAPTER V, 


REPRODUCTION. 

Cell Division.—Tissue grows by the multiplication of its 
cells. This multiplication is through continually repeated 
subdivision, each new cell soon reaching the approximate 
size of the parent cell. In higher forms of life, the cell’s 
reproductive power lies in the part of its nucleus called 
chromatin, which is distinguishable from other parts by 
staining characteristics. 

Division begins with a separation of the chromatin into a 
number of segments, or chromosomes, the number for the 
cells of any single species being constant. Then the chromo¬ 
somes all split and thus double in number, allowing a full 
set for each of two daughter nuclei into which the nucleus 
divides. Both young nuclei take part of the surrounding 
protoplasm. Cellular reproduction of this nature is termed 
asexual, as contrasted with the occasionally intervening 
sexual cycles to be described presently. 

Tissue Balance.—A balance develops between different 
tissues, such that the cells of one do not overgrow those of 
another. In general, one organ proceeds no farther in its 
growth than to a point of greatest usefulness to the others. 
The many factors behind this balancing of growth are not 
understood; some seem to be intrinsic and others extrinsic 
to the cell. In large measure, the characteristics of the whole 
mass of tissue into which a cell will eventually develop are 
determined by the nature of its tiny speck of chromatin. 
Many of the extrinsic influences belong to the subject of 
nutrition, to be discussed in a later chapter. Some of the 
internal secretions, poured into the blood stream by certain 
glands, are also among the influences from outside the cell. 

Alteration in the internal secretion of the pituitary body 


8G 


THE FOUNDATION OF HEALTH 


at the base of the brain causes disproportionate overgrowth 
of parts of the skeleton, and leads to gigantism. In the 
testicle or ovary is some tissue (interstitial cells ) which supplies 
an internal secretion necessary for the maturity of the sexual 
organs and the production of the various male and female 
characteristics. Such influence on the reproductive power 
of certain tissues affects their balance with the others, and 
makes of the body one organized whole. 

Internal Secretions.— The selective effect on tissue activity 
is one of many influences which the internal secretions have 
on the body’s mechanism. The secretion of the thymus 
gland influences greatly the general tissue growth in early 
years, and that of the thyroid and other glands that through¬ 
out life. The circulation of the blood is regulated in part 
by adrenal and pituitary secretions. Secretions from some 
islands of cells (islands of Langerhans) in the pancreas cause 
the conversion of sugar to glycogen, a necessary factor of 
nutrition. 

A deficiency of internal secretion can sometimes be reme¬ 
died by the administration of corresponding glandular mate¬ 
rials from lower animals. Thyroid extract is fed with advan¬ 
tage, and extracts from the adrenal glands, the pituitary 
body, or the pancreatic islands, are injected. Additional 
results have been obtained experimentally by transplanting 
glands from one animal to another; in the case of testicular 
transplants, practical application has unfortunately gone 
beyond the experimental promise. 

Tumors.— The most serious disturbance of tissue balance 
results when local groups of cells lose the restraint of balanc¬ 
ing factors, and proceed to displace other cells. Newgrowths, 
or tumors, are masses of diseased cells which grow beyond their 
proper confines. Why they do so is as hard to understand 
as why the healthy tissue cells do not; the cause of tumors is 
unknown. The risk of contracting cancer or other tumorous 
disease is not increased by association with one affected; the 
disease is not even mildly contagious. Carcinoma, the most 
menacing of tumors, is unlikely to occur until the latter half 
of life; the age of greatest susceptibility is from forty-five to 
sixty-five years. 


REPRODUCTION 


87 


The benign tumors remain localized in the tissues where 
they first appear, and do little harm. The cells of the fatal 
malignant tumors invade many tissues, until one organ after 
another is involved. Clumps of the malignant cells can 
be carried by the blood to a distant part of the body, and 
there take root and grow. The carcinoma is a malignant 
growth of epithelial cells, and the sarcoma one of other cells. 
The term cancer is applied to each of these, but more gener¬ 
ally to carcinoma. The only cure is by surgical removal of 
the tumor; every cell growing wild must be included in the 
tissue taken out. This is possible only in an early stage, 
before extensive growth has taken place. 

Aging of Cells.— The normal reproductive forces of the 
tissue diminish in power as age advances. The body’s rate 
of growth declines from birth on. As old age approaches 
the new cells being formed have smaller nuclei and lower 
reproductive power than had their distant predecessors. 
Aged tissue repairs itself more slowly after injury than does 
younger. Tissue cells are saved from aging to the point of 
the species’ extinction through the intervention of germ- 
cells, specialized for species reproduction; the latter are not 
affected by the aging of their predecessor cells. These can 
give rise to cells with entirely renewed powers of growth. 

Certain of the plants have reproductive spores which 
develop asexually, but the common type of cell for species 
reproduction is sexual, both in plants and animals. Half 
of the chromatin is extruded from the cell, and further 
reproduction into young tissue takes place only if the full 
amount is restored by the fusion of another cell with its 
reduced share. The outgrowth of the fusion of a male and 
female cell is tissue with fully active reproductive power. 

Germ-cells.— Sexual development is not limited to multi¬ 
cellular beings; some of the single-celled animals occasionally 
pass through a sexual stage in the course of their procreation. 
The asexual multiplication of the protozoal parasites of 
malaria is at first rapid, but wanes in a few weeks. Then 
there come into prominence some sexual cells, also formed 
in the course of the parasite’s multiplication, which if drawn 
into a certain kind of mosquito can unite, a male with a female 


THE FOUNDATION OF HEALTH 


cell; from the union are evolved cells which have a fully 
renewed power of growth when introduced by the mosquito’s 
bite into another person. 

Correspondingly, the cells of the human body multiply 
asexually, though they retain an interdependence unknown 
to the protozoa. By the end of childhood this asexual devel¬ 
opment subsides in vigor and about then there begins a forma¬ 
tion in the reproductive organs of sexual cells. 

Puberty.— From the germ-cells in the testicle are formed 
male cells (spermatozoa), which are thrown off by the million. 
The corresponding female cells (ova) are formed in the ovary 
and thrown off singly. At intervals of about four weeks a 
blister-like vesicle forms on the ovary, and its rupture 
releases some fluid which contains the ovum. Each of the 
two kinds of sexual cells has its chromatin so reduced that only 
by fusion with the other can it form the number of chromo¬ 
somes required in the human species for cellular reproduction. 
Each holds in its share of the chromosomes determinants of 
the parent body’s characteristics, deriving them from the 
preceding generations of germ cells which had given rise to 
that parent body. 

The ovary continues to form sexual cells for about thirty 
years, the testicle throughout life. The beginning of this 
sexual activity, or puberty, is marked by obvious changes in 
the body. The male voice changes its pitch, and a beard 
begins to grow. Even more definite changes appear in the 
female. Puberty occurs at about the fourteenth year, some¬ 
what earlier in southern than northern peoples. 

Menstruation.— The most definite sign of puberty in the 
female is the beginning of menstruation. A period is asso¬ 
ciated with each monthly liberation of an ovum. It is a 
result of the uterine mucous membrane having undergone 
congestive changes suitable to the nourishment of the ovum, 
had the fusion with a male cell taken place. When the ovum 
is not fertilized, the congested vessels break and some four 
to eight ounces of blood escape. 

The headache, depression, and other occasional symptoms 
are due not to the blood lost, but to other effects of the ovar¬ 
ian activity. The period should never cause very marked 


REPRODUCTION 


89 


disturbance, and if it does the probability arises of some 
physical disorder. Pain during menstruation {dysmenorrhea) 
is predisposed to sometimes by pelvic trouble. It is the more 
likely to occur after carelessness about exertion, chilling or 
constipation. The healthy girl can continue her daily 
routine of exercise and bath, but may feel adversely the 
effects of too strenuous exertion, or of a bath which is too 
hot or too cold. 

Female Genital Tract.— Malposition of the uterus in the 
pelvis is one cause of menstrual disturbance; it also may 
cause backache and perhaps irritability of the bladder or 
other symptoms. An abnormal position of the uterus does 
not necessarily cause disturbance, and unless it does calls 
for no treatment. Malposition can result from congenital 
defect, from childbirth, or from excessive strains involving 
abdominal pressure. 

At the inner end of the uterus are connected two tubes 
{Fallopian tubes) which are open at their further end to 
receive from the two respective ovaries the ova. It is usually 
in these tubes that the ova are fertilized, the male cells from 
the outer passage having entered and made their way through 
the uterus. 

Male Genital Tract.— The male genital tract includes the 
two testicles, and connecting with each a tube {ms deferens) 
to carry the spermatozoa toward the exterior. At a place in 
the groin the tubes lie just beneath the skin. An operation, 
which consists simply in breaking the continuity of the tubes 
here {vasectomy) is used to prevent males with hereditary 
criminal tendencies from having offspring. 

Before the spermatozoa leave the genital passageway, 
there is mixed with them a secretion from the prostate gland, 
which increases their motility and aids any migrations toward 
the ova. An emission of such secretion {semen) also occurs 
at times during sleep, quite independently of sexual practices, 
a normal occurrence of no hygienic significance. 

Pregnancy.— When an ovum is fertilized by a male cell, 
it implants itself in the mucous membrane of the uterus, 
where warmth and nourishment enable it to pass the early 
stages of cellular multiplication. Only after nine months’ 


90 


THE FOUNDATION OF HEALTH 


growth can the tissues of the baby develop independently of 
those of the mother. Placental tissues of mother and of 
baby are in contact and permit an interchange of fluids from 
the blood stream of the one to that of the other. All tissues 
of the two are distinct, and except at the placenta are sepa¬ 
rated, throughout pregnancy. The supposition of a prenatal 
influence on the baby of the mother’s thoughts or experiences 
is entirely without basis, for no determinant of a bodily peculi¬ 
arity could possibly be dissolved in the body fluids, and there 
is no other means of communication between the two. 

Proper medical attention during this period of pregnancy 
is conducive to the welfare of both, though in general the 
mother’s mode of life need not be changed. Moderate exer¬ 
cise may be continued, but not overexertion or heavy lifting. 
The periods allowed for rest should be made sufficient for 
avoidance of fatigue. The diet is regulated to prevent con¬ 
stipation or any considerable increase in weight. Solid diet is 
continued; symptoms of nausea are aggravated less by it than 
by a soft or liquid one. The teeth tend to become carious, 
due to the baby’s heavy demand for calcium, and should be 
put in order early in pregnancy and regularly cared for; the 
calcium and vitamins of the diet are not to be neglected. 
It is best to remain under a physician’s supervision through¬ 
out, as some unsuspected ailment might interfere with the 
pregnancy, or some such complication as nephritis might 
result from it. 

Child-birth.— The extent to which preventable ailments 
have attended child-birth lends emphasis to the urgency of 
competent medical attendance. The attention of a meagerly 
trained midwife is a very poor substitute, and fortunately this 
is being more and more generally realized. Accidents of 
delivery endanger both baby and mother. One danger is 
that of a pelvis so deformed as to hinder the birth of a child 
through it; the physician would look into this possibility 
early in pregnancy. 

The most prevalent of the serious infections which attack 
the child during birth is gonorrheal ophthalmia, which leads 
often to blindness. In order to reach all babies which might 
be exposed to this infection, many States have the wisdom 


REPRODUCTION 


91 


to require that antiseptic drops be put in the eyes of every 
baby born. The tuberculosis hazard begins immediately 
after birth, and babies should not be left in the care of 
actively tuberculous mothers. The syphilitic mother, on the 
other hand, could safely care for her child, as any transmis¬ 
sion of her infection would have been before birth. 

Marriage.— More of the congenital diseases are trans¬ 
mitted long before than at the time of birth; some begin at 
the time of conception. 

The congenital disease is any that the parent transmits to 
a child at or before its birth. It may be hereditary or it may 
be an infectious disease transmitted through the placenta dur¬ 
ing pregnancy. Long-standing alcoholism of the parents 
leaves its imprint on the child’s health, due probably to 
defective nourishment through the placenta. 

The control of congenital disease is possible in large meas¬ 
ure through suitable marriage. Not only the hereditary dis¬ 
eases, but such communicable ones as syphilis and tubercu¬ 
losis frequently enter the family at marriage. A preliminary 
health certificate sought in good faith by all parties is a wise 
safeguard against many such diseases. As a general com¬ 
pulsory measure its value is limited by the examinee’s 
opportunities for dissimulation. From physical signs and 
laboratory test alone, the physician cannot always detect 
an infection which is carried or mildly suffered, nor can he 
ascertain the hereditary traits in a family unless its history 
is truthfully presented. 

Hereditary Disease.— The hereditary disease begins at the 
time of conception, when the male and female cells first 
unite. Among the hereditary defects are some gross deform¬ 
ities, certain disorders of the eye, the “bleeder” condition 
(hemophilia) and some nervous and mental diseases and 
deficiencies. All do not follow the same rules of transmission. 
The condition of the bleeder or color blind person is sex- 
linked in transmission; the inherited trait does not equally 
affect both sexes. In many cases the mode of inheritance is 
not understood. Generally, the determinants of hereditary 
disease proceed not from one but from both of the parents. 
The disease is a defective trait, transmitted just as many 
other traits are, in accordance with Mendel’s law. 


92 


THE FOUNDATION OF HEALTH 


Mendelian Inheritance. —Where traits inherited from the 
two parents are antagonistic and cannot both characterize 
the offspring, only the predominant of the two reveals itself. 
The other is hidden ( recessive ) but is nevertheless present 
and still transmissible. Parents, the one perfectly sound 
in some given respect and the other quite defective in this 
respect, pass to each child both the sound and the defective 
traits. This may be diagrammed as in Fig. 12. 

y 

\ 


; / \ *. X \ 

$-j> S D 5-D 

Fig. 12.—Transmission of sound and defective traits. 



None of the children prove to be defective, assuming for the 
present that the sound trait predominates and the defective 
trait is recessive, as only the dominant trait appears. A pro¬ 
ducer of hereditary disease is present, but it is so well resisted 
by the accompanying sound trait that no disease results. Such 


Sd) S'B 



$'-s' s-jp 

Fig. 13.—Transmission of sound and defective traits. 

a person, on becoming a parent, could transmit either trait; 
four children might be endowed as in Fig. 13. This is purely 
a chance distribution, just as pairs of cards drawn one from 
each of two decks are equally likely to be two red cards, a 
red and a black, a black and a red, or two black. Three- 
fourths of the children indicated in Fig. 13 have either 



REPRODUCTION 


93 


sound traits only, or sound traits to resist and prevent any 
evidence of the coexisting defective traits; the remaining 
one-fourth is frankly defective. If the trait of disease here 
were dominant instead of recessive, the three-fourths would 
inherit its evidences; there would not be the inherited 
resistance. 

An important consideration is that one whose near relative 
has an inheritable defect cannot always be sure that he also 
does not have it hidden away; if not dominant in type it may 
be present in him and transmissible, though not evident. 
His children can develop this disease, however, only if the 
other parent’s family runs the same trait. The danger to 
offspring from a marriage of cousins or of other closely related 
persons is that any defective trait carried by the one is as 
likely to be carried by the other too. 

Dominant traits may lead to certain deformities of the 
extremities, to bony fragility, to presenile cataract, and to 
chronic chorea ( Huntington's ). On the other hand, traits 
must be inherited through both parents to be capable of 
causing albinism, feeble mindedness, retinitis pigmentosa, 
hemophilia, and color blindness. In the case of many 
inheritable human traits dominance is not clear. Suitable 
selections for marriage are such that both of the families 
do not carry any hereditary defective trait, and that neither 
party shows the effect of a defective trait known to be 
dominant. This protects the following generation from the 
bad qualities transmissible through inheritance. 

Prevention of Conception.— The ultimate wiping out of 
hereditary inferiority is to be accomplished only through an 
overgrowth of the less gifted classes by the more gifted, a 
matter of relative rapidity of procreation. Mental inferiority 
seems to be one of the traits most menacing to the race 
because there is at present little promise of its being over¬ 
grown. Those with high-grade mentality have much smaller 
average families than do the poorly endowed, and it is the 
latter who are providing for the eventual survival of their 
kind. A much neglected responsibility of intellectual people 
is that of carrying on their inheritance to future generations. 
This hazard has been increased by widespread prevention of 


94 


THE FOUNDATION OF HEALTH 


conception among certain sorts of educated people, unheed¬ 
ful that successors will be as much needed as are they in the 
world. The practice is less reprehensible than that of infan¬ 
ticide or of criminal abortion, but its effect on the race is 
the same. 

The recent movement to make such a practice available 
equally to the untutored would, on the other hand, serve to 
reduce incompetence in future generations. Some of the 
authorities on eugenics and social uplift have advocated this. 
Many would fully enlighten everyone on all sex processes, 
and their control. 

Sex Education.—Others hesitate to go so far with sex edu¬ 
cation, though it is clear that people should know more about 
sexual and venereal problems than they now do. The better 
understanding of these problems spread among college 
students of recent years has definitely reduced the prevalence 
of venereal disease. Information acquired by the students 
from companions has been mingled, however, with much 
misinformation. No one doubts the superiority of systematic 
teaching over this haphazard acquisition of information. 

The only phase of sex education which has had proper atten¬ 
tion until recently is the moral one which enters into religious 
training. The influence of the churches has promoted such 
organization of the mind as to bring impulses of sex closer 
to family sentiment; it has resisted licence, masturbation, 
or day dreaming over sexual matters, with their attendant 
hazards to health. It covers only part of the problem at 
best, however, and does not reach half of the people at all. 
A helpful and correct understanding of sex hygiene can be 
given to the masses only through the school system. This 
would not replace but would extensively supplement the 
moral training. The subject is best taught to classes for 
boys and for girls separately, a little before the age of puberty 
is reached. 

As a preliminary to the teaching of sex, both the lower 
grades and the home can enlighten on the general scheme of 
reproduction. Life histories of plants make interesting 
stories, and even for little children may include the sexual 
process of pollenization. The evolvement of the butterfly, 


REPRODUCTION 


95 


through fertilized egg, caterpillar, and cocoon, can follow, 
and later that of some higher forms of life. The growth is 
always traced along from the two sexual cells. The child 
comes to think correctly instead of imperfectly and suggest¬ 
ively of reproduction. The venereal hazards can wait for 
the formal instruction on sex. 

Venereal Disease.—Venereal diseases are those especially 
prone to be contracted through sexual contact with an 
infected person. There are several of them, of which two, 
syphilis and gonorrhea, are quite serious. The former creates 
the greater havoc to the tissues and functions of the body; 
the latter is the more widespread. Syphilitic infection ordi¬ 
narily enters through an abrasion, most often in the mucous 
membrane but sometimes in the skin. Infection requires 
so little abrasion that an average moist membrane is hardly 
a barrier at all. Gonorrheal infection attacks only the 
mucous membrane, but does not require any abrasion what¬ 
ever. 

Germ of Syphilis.—The germ of syphilis (Treponema 
pallidum: Spirochoeta pallida ) is one of a group of long spiral 
parasites lying close to the animal kingdom, or possibly in 
it. The germs are killed by a few hours’ cooling to room 
temperature, and much more quickly by drying. Any which 
have been carried away from human tissues are not a men¬ 
ace, even during the short remainder of their life. Many 
authorities are dissatisfied with the evidence which suggests 
a transmission of syphilis by drinking cups, towels, and other 
lifeless objects, though such transmission to a person who 
uses the articles immediately after the patient does would 
not seem to be impossible. Practically, transmission requires 
immediate transfer to an abrasion on the recipient of some 
infected body fluid from the syphilitic person. 

The infected spot inflames after a few weeks into the 
characteristic hard chancre (primary stage of syphilis) . Gen¬ 
eral symptoms (secondary stage), including fever, aching, and 
rash, appear several weeks later. The germs have by then 
accumulated and are being combated by the immune bodies. 
At this stage the disease is more highly infective than at 
any other period. The spirochetes die off largely after a 


96 


THE FOUNDATION OF HEALTH 


few more weeks, but scattered tissues continue to breed them 
and react with a type of inflammation called the gumma 
(tertiary stage). A still later stage involves parts of the 
brain or spinal cord, leading in the one case to a form of 
insanity (general paresis), and in the other to a permanent 
muscular incoordination (locomotor ataxia: tabes dorsalis). 

Infection is usually by contact involving the genital mucous 
membrane. The disease is kept alive and disseminated 
through promiscuous sexual habits. Half of all people 
infected are innocent of such habits, however. This latter 
half are infected through family relations, or through the 
so-called accidental infections independent of sexual contact. 
Anyone might get some infected blood into a skin abrasion 
while giving to a syphilitic person the first aid for a bleeding 
wound. Saliva commonly transmits syphilis to those with 
cracked lips, through kissing. Popular prejudice against 
smallpox vaccination has sometimes fallen into the argument 
that syphilis can thereby be conveyed; rare instances may 
have occurred formerly when vaccinations were made with 
scabs from previously vaccinated persons, but the possibility 
is entirely precluded by the cattle lymph method now in 
general use. 

Family Infection.— Closest associations mean greatest 
exposure to syphilis, and the members of the patient’s imme¬ 
diate family suffer most. When any member of a family is 
found to have syphilis, the others should be examined for it 
by laboratory test (Wassermann reaction), for they may 
have been infected without realizing it; the clinical picture 
is not always typical. Wives commonly become infected 
from their husbands; while infected they may have babies 
which contract the disease even before their birth, through 
placental infection. 

The responsibility for preventing a spread of the infection 
through the family rests with the patient; those of them with 
any principle at all live up to it. Part of the medical advice 
given to syphilitic persons concerns the protection of others. 
The disease is curable, entirely in most cases and to the point 
of non-infectivity in the rest, though many months or even 
years must sometimes be devoted to the cure. 


REPRODUCTION 


97 


Congenital Syphilis. — Congenital syphilis, acquired by 
babies before their birth, is from an infected mother. The 
probability of a prenatally transmitted infection, and the 
severity of one if acquired, depends on the degree of infectivity 
of the mother’s body fluids. An untreated infection in the 
secondary stage would almost surely be transmitted to the 
child; the probability decreases with the lapse of time since 
this stage. Active treatment greatly reduces the infectivity 
of the body fluids, and if continued throughout pregnancy 
gives the child a chance for healthy birth. 

Heavily infected babies die before or shortly after birth. 
The more mildly infected develop symptoms usually within 
a few weeks. The baby then becomes irritable and loses 
weight; its nose runs, cracks and lesions appear on the mucous 
membrane of the mouth, and the skin breaks out with various 
forms of rash. A later stage involves fairly characteristic 
deformities of the teeth, stunted growth and changes in 
bones, eyes and ears. Sometimes the disease does not be¬ 
come evident until late in childhood. 

The acute symptoms of infancy mark the very infective 
stage of congenital syphilis. Healthy wet nurses who nurse 
syphilitic babies are in danger, and such babies are often 
too delicate to thrive except on breast milk. The nurse’s 
health should be guarded by pumping the breasts and then 
feeding the milk to the baby from a bottle. Conversely, 
syphilitic wet nurses endanger healthy babies; wet nurses 
should be employed only after a Wassermann test has indi¬ 
cated their freedom from the disease. As the little patient 
outgrows babyhood, the danger subsides of a transmission 
of its infection to others, and after early childhood this 
danger is practically nil. 

Gonorrhea.—The germ of the other venereal disease men¬ 
tioned is a pus producing bacterium {gonococcus ), the cells 
of which appear under the microscope as pairs of somewhat 
flattened spheres. This germ attacks most readily the 
membrane covering the front of the eye and that lining the 
genital tract. The conjunctiva is exceedingly susceptible, 
and the infection spreads rapidly over it. The membrane 
of the genital tract offers somewhat more resistance and 
7 


98 


THE FOUNDATION OF HEALTH 


the infection limits itself as a rule to the area near the 
exterior. 

Not infrequently, however, the infection spreads over the 
entire membrane and involves all the genital passageways; 
the only organ to escape is the testicle or ovary. Some of 
the organs are likely to remain chronically infected, unless 
the disease is actively and skillfully treated; the infected 
person continues for a long period to be infective to others. 
Prostitutes nearly always harbor an infection, which they 
have acquired at some previous time; they are always danger¬ 
ous as transmitters of this disease and of syphilis. 

Sequelae .—The final result of a gonorrheal infection may 
be small or great according to the extent of the inflammation. 
Invasion of the underlying tissue occurs, which in the case of 
the eye leads often to blindness and in that of the genital tract 
to an extensive formation of scar tissue. Sterility of either 
male or female occurs, due to an obliteration of passages by 
the scars or to other injury. The gonococcus can also be 
transported through the blood stream to other tissues and 
set up complications in joints, heart, or other organs. Cases 
of gonorrheal rheumatism are frequently encountered by 
physicians; this complication resists treatment and is over¬ 
come with difficulty. 

Prevention .—Prevention of gonorrhea is by the avoidance 
of gonorrheal discharges. The pus may be regarded as 
dangerous until it dries, or for possibly as long as a day. The 
germ is much shorter lived than most other pus bacteria, but 
it does not die off as soon after leaving the body as does the 
germ of syphilis. 

Generally effective measures for preventing the infection, 
after gonorrheal contact, consist in the thorough flooding of 
the exposed part of the membrane with one of the silver anti¬ 
septics. The eye membrane or the genital membrane should 
be so treated immediately, if there is any suspicion whatever 
that gonorrheal pus may have reached it. The treatment is 
to be given very thoroughly and wherever possible by a 
physician. 

Accidental Infections .—The usual forms of gonorrhea trans¬ 
mitted otherwise than through sexual contact are conjunc- 


REPRODUCTION 


99 


tival infections {gonorrheal ophthalmia ), and genital infections 
in little girls {vulvovaginitis of children ). Public toilets often 
are reported to cause genital infections in adults, but such 
claims are made for the avoidance of embarrassing admis¬ 
sions. A dirty toilet might conceivably transmit gonorrhea, 
as well as typhoid fever and other infections, but the danger 
is slight. 

Gonorrheal ophthalmia has already ha,d brief mention. It 
follows a conveyance of gonorrheal pus to the eye, by con¬ 
taminated hands, towels, etc. Those who care for a patient 
with any type of gonorrhea should use particular care not 
to infect their own eyes. If pus is known to reach the eye, 
argyrol is immediately to be dropped in; but a physician 
should be seen too. After this infection develops, only the 
most careful treatment can save the eyes. 

Vulvovaginitis.—Genital membranes of girls under five are 
infected by the pus from diseased mothers or attendants; 
this occurs so frequently that many institutions make a 
routine laboratory examination of every girl admitted, in 
order to avoid the introduction and spread of the disease 
among their young inmates. Institutional epidemics have 
sometimes been controlled with great difficulty; the germ is 
readily transmitted by articles used in common, and is carried 
by convalescents for a long time. 

An infected child in the household should always be isolated 
from the non-infected until cured. Even after apparent cure 
and repeatedly negative laboratory test, the case is liable to 
relapse. Clothing and other articles used by the patient 
should be kept to themselves when dirty, and thoroughly 
cleaned or where possible boiled before coming into contact 
with those used for others. Attendants should wash thor¬ 
oughly after handling the patient. 

Transmission is more likely to result from thoughtless 
neglect of precautions than from faults in the precautions 
employed, for it is not hard to destroy these germs when away 
from the body. Adult patients and their attendants should 
be equally cautious to avoid further transmission, and should 
keep in mind constantly the two routes of accidental infection. 


100 


THE FOUNDATION OF HEALTH 


Leucorrhea.—Chronic vaginal discharge, usually of a 
whitish appearance and therefore called leucorrhea, is not 
uncommon. It is largely a product of uterine or vaginal 
glands, excited by gonorrhea or other irritative condition. 
An inoffensive discharge in girls might indicate the vulvo¬ 
vaginitis just described, or masturbation, or an infestation 
with pinworms. Pregnancy leads to some discharge, as 
might also uterine malposition or defect, or a congestion due 
to systemic infectious disease. A bad odor suggests that the 
discharge has been retained for some time or that it is asso¬ 
ciated with decay of tissue. A very offensive or bloody dis¬ 
charge during middle or advanced age is suggestive of cancer; 
after reaching any considerable size the cancerous tissue 
decays, as the center cannot get nourishment at its distance 
from the blood supply. Leucorrhea is always a symptom 
which bears investigation. 

Reading. * 

General, J. F. Williams, Chapter XII. 

Sex Hygiene and Disease, Winslow, Chapter IX. 

Healthy Parents, Scurfield, Chapter I. 

Inheritance of Disease, Rosenau, Section IV, Chapter III. 

Eugenics and Inheritance, Fisher and Fisk, Supplementary 
Notes, Section IX. 

Sex Education, Rapeer, Chapter XXIX. 

Venereal Disease, Lee, Chapter XIV. 

* See bibliography for titles and publishers of books. 





CHAPTER VI. 


THE DIGESTIVE SYSTEM. 

Digestion of Foods.—The alimentary system digests and 
passes into the tissues the nutritious portion of articles 
ingested. Both animal and vegetable food contains, besides 
the nourishing food elements, much water and non-nutritious 
bulk. This is first crushed with more water into a thick fluid 
{chyme), for which purpose it is chewed and then churned 
about by muscular activity in the gastro-intestinal tract. 
The tract then proceeds, by means of ferments poured from 
glands into the food mixture, to change the nutritious matter 
chemically into suitable form for the tissues’ use. The 
digested nutritious substance, dissolved in the water present, 
is finally absorbed through the mucous membrane into vessels 
which distribute it to the tissues. 

Peritoneum.—The gastro-intestinal tract is held in place 
by a membranous sheet, consisting principally of a strong 
feltwork of fibrous tissue. This membrane ( peritoneum) is 
in many respects unlike the mucous membrane described in 
an earlier chapter. Large, flat cells cover it and give it a 
smooth and glistening surface. It lines the abdominal cavity, 
from the posterior wall of which it is slung forward to fold 
around the gastro-intestinal tube and double on itself back 
to the abdominal wall. The bowel is thereby furnished a 
firm hanging support, and yet retains freedom for muscular 
activity. Other abdominal organs are similarly suspended. 

If hereditary defect renders the support too loose, the 
viscera gravitate toward the bottom of the cavity (viscerop¬ 
tosis). Most of the attempts at surgical correction of this 
condition have been unsuccessful; a properly adjusted abdom¬ 
inal supporter offers greater relief, though not a cure of 
course. 

Adhesions.—Abdominal inflammations, as for instance 
chronic appendicitis, operative wounds, or other scar-pro- 


102 


THE FOUNDATION OF HEALTH 


during injuries, may cause parts of the peritoneal sheet to 
adhere together. Such adhesions have caused kinking and 
even obstruction of the bowel, but this is rare. Most adhe¬ 
sions are harmless. As a rule no symptoms result, though 
occasionally dull pains and drawing sensations may be felt. 
Most of these eases that give trouble cannot be cured sur¬ 
gically, because new raw surfaces left by the operation would 
only give rise to more scar formation. Mild symptoms from 
adhesions are best disregarded. 

Hernia.—The openings about structures that pierce the 
lower abdominal wall are normally closed by the peritoneum 
and other fascial support. In some persons the closure is 
faulty, and this permits a loop of bowel to work its way 
through the opening ( hernia: rupture). The condition is not 
due primarily to any strain which might first force the bowel 
through, but to the inherent defect. It can be corrected sur¬ 
gically, and in most cases of pronounced hernia the operation 
is advisable. Hernia might also occur through an old opera¬ 
tive wound, particularly if long drainage of pus through the 
wound was necessary. 

The greatest danger from hernia is strangulation; tissues 
about the opening close in on the loop of bowel and shut off 
its circulation. This is followed by intense pain in the region, 
a symptom which calls for immediate surgical care; delay of 
the operation for strangulation, even for a day or so, would 
probably cost the patient his life. 

Structure of the Tract.—The peritoneal membrane forms 
the outermost of four coats making up the gastro-intestinal 
tube. The innermost is the mucous membrane through which 
the dissolved foods are absorbed. Next to this is a coat of 
loose fibrous tissue (,submucous coat), which contains small 
vessels to collect the absorbed material and pass it on to 
larger vessels for distribution. Between the submucous coat 
and the peritoneal covering is the coat of muscles, the churn¬ 
ing activity of which has been mentioned. 

Parts of the tract specialize for the respective steps of the 
digestive function. Strong muscular rings ( sphincters) 
divide the tube into sections, each of which qualifies for a 
stage of the process. The first ring (cardiac sphincter) sepa- 


THE DIGESTIVE SYSTEM 


103 


rates the esophagus from the rest. Another (pyloric sphincter) 
develops farther down, and the tube between these two rings 
enlarges into the stomach. The tube below the latter ring 
constitutes the bowel or intestine. A third ring ( ileo-colic 
sphincter, at the ileo-cecal valve of the mucous membrane) 
divides the bowel into two sections. The first section 
lengthens greatly into the small bowel. The lower section 
enlarges and lengthens into the large bowel or colon. A 
final ring (anal sphincter ) closes the end of the tube. 



Esophagus.—The first section of the tract, the esophagus or 
gullet, serves only to bring food and water to the stomach. 
Solids are forced along by muscular action. Such action here 
or elsewhere in the tract is termed peristalsis. Peristaltic 
waves are muscular constrictions, which in the esophagus 
begin with the voluntary contraction of the muscles of the 
throat and pass downward to the cardiac ring; the latter 
relaxes to admit the food into the stomach. The esophagus 
has no peristalsis in the reverse direction; the force of vomit¬ 
ing is entirely from contraction of the stomach and abdominal 
muscles. 





















104 


THE FOUNDATION OF HEALTH 


The horse and other animals which drink upward have 
water carried to the stomach by peristaltic waves, but in man 
liquids simply gravitate downward after being started by 
the throat muscles. Drinking with the mouth half full of 
solid food, for which children are so often reproved, hinders 
the throat muscles from properly starting the activity; it is 
this that sometimes causes the fluids to gravitate into the 
windpipe. 

Belching.—Some people swallow too much air and as a 
result habitually belch. Sometimes a little more air is 
swallowed in the motion of belching, and then this is belched 
up, so that the repeated action runs into a series. Neither this 
habit nor the presence of gas or air in the gastro-intestinal tract 
is particularly suggestive of any fermentative disorder; the 
latter may cause belching, but does so less often than does 
the swallowing of air. A quantity of gas or air is present in 
the tract normally, and the habit of swallowing merely aug¬ 
ments the amount; no harm is done. 

Foreign Bodies.—Fish bones or other small objects swal¬ 
lowed are likely to dp all their damage before they reach the 
stomach; Removal by surgical instruments is occasionally 
necessary when they stick in the esophagus, though usually a 
big swallow of food or water will take them past the danger 
zone. An object which sticks in the throat of a child can 
usually be hooked out with the finger. The finger should 
be carefully worked around and behind it, so as not to force 
it into the windpipe. The manipulator’s hand is protected 
if the child’s cheek is pressed in between its teeth. Objects 
will often drop out if the child is held upside down by the legs 
and pounded on the back to start coughing. 

Stomach and Intestine.—In the stomach, food collects and 
receives a portion of the digestive juices. The upper and 
more dilated part of the stomach {fundus) holds the material 
and feeds it gradually into the lower part, or pylorus , which 
is more constricted and muscular. Peristaltic waves, which 
keep driving down against the closed pyloric ring, crush 
together the food and water in the pylorus. As digestive 
juices have also been poured in, the food mixture becomes a 
thick and partly digested fluid. Hydrochloric acid, from 


THE DIGESTIVE SYSTEM 


105 


some of the secreting cells of the stomach, plays a part in 
the digestion of protein foods and in the closure and opening 
of the pyloric ring. The ring opens at intervals and lets 
part of the mass into the small bowel for further digestion 
and absorption. 

The muscular coat of the tube provides the movements 
for stirring up and pushing along the food matter. There is a 
circular layer of muscle, and outside this another layer 
directed lengthwise; their contraction squeezes in on the 
tube and pulls the constrictions along. Types of peristalsis 
in the esophagus and stomach have been mentioned. The 
small intestine has two types of peristaltic action, one of 
which consists in simply squeezing at one place and then 
another, and the other in having the constrictions pulled 
for a short distance down the tube. A third form, which 
sweeps the entire length of the bowel, occurs only in abnormal 
diarrheal conditions. 

The peristaltic action of the muscles is in response to nerv¬ 
ous stimulation, mainly through networks of nerves. One 
such network ( Auerbach’s plexus) is between, and another 
{Meissner’s plexus) just within the two muscle layers. Sen¬ 
sory elements about the mucous membrane communicate 
with them. Substances within the tube stimulate these 
nerves mechanically and chemically and bring about the 
contractions. In this way, the food mass itself institutes 
such muscular activity as will mix it and force it along the 
tube. 

There are also connections with the general nervous system 
of the body. This permits mental conditions to influence 
the digestive activity. Strong emotions definitely interfere. 
Worry, fear or anger may inhibit the contraction of the 
stomach and spoil the appetite. They also cause constipa¬ 
tion, and terror may cause diarrhea. The favorable effect 
on the digestive processes of an after-dinner smoke is due in 
part to a soothing of emotion, though there is also a direct 
stimulation of the taste nerves which would play some 
part. 

Feeding Habits.—The various digestive activities are so 
correlated that one stimulates another to action. The taste 


106 


THE FOUNDATION OF HEALTH 


of food in the mouth reacts to produce digestive secretions 
in the stomach. The whole process is thereby set in motion. 
Haste in swallowing food reduces the primary taste stimulus, 
whereas leisurely eating with slow mastication acts more 
favorably. It is unlikely that this favorable influence is due 
entirely to the more complete maceration of the foods, as 
has often been assumed. Music at meal time promotes a 
tendency to relax and eat slowly, and to this extent aids 
digestion. 

The digestive activity is favored also by regularity of 
habit. Regular hours for meals mean better appetites. 
Babies fed irregularly, according to when they wake up or 
when they cry, have the discomfort of irregularly timed 
hunger pains. They do better if fed on a regular schedule. 
The digestive tract needs regular periods of rest between 
successive feedings. These should be not less than four hours, 
as a rule, even for babies. Eating between meals or too 
frequently spoils the appetite and produces in many persons 
unpleasant symptoms. 

Dyspeptic Symptoms.—The uncomfortable, sour, and heavy 
feeling sometimes called indigestion or dyspepsia indicates 
some physical disorder. The symptom does not, however, 
tell what part of the body is disordered. It may result from 
tooth or tonsil disease, from stomach ailments of one kind 
or another, from constipation, or from improper diet or too 
rapid eating. It may even result from disorders entirely 
foreign to the tract, such as mental or cardiac trouble. As a 
danger sign, this symptom is therefore of very limited value; 
it does not locate the danger, which frequently is hardly 
enough to justify diligent search. The management depends 
on what other symptoms and signs accompany it. Tempor¬ 
ary relief is often obtained by taking a little baking soda. 

Fancy diets tax the digestive function of some persons and 
cause dyspeptic symptoms. So do highly spiced foods; 
spices and condiments are sometimes thought to irritate 
the mucous membrane and thus alter the secretions. Fried 
and greasy foods are often troublesome, perhaps because the 
fats coat over and withhold the food temporarily from diges¬ 
tive juices. It is manifestly unwise for persons so troubled 


THE DIGESTIVE SYSTEM 


107 


to continue this sort of diet. Very hot or very cold foods, or 
hasty eating, can provoke symptoms. 

Dietetic Fads.—Within the limit of the nutritional require¬ 
ments to be outlined presently, there would seem to be no 
reason for condemning any of the dietetic mixtures which do 
not produce dyspeptic or other symptoms. Many popular fads 
concerning diet are quite devoid of foundation. Grounds for 
the widespread fear of milk in combination with shellfish or 
fish are principally imaginative; ill-effects from contaminated 
shellfish, or possibly from the eating of shellfish by hyper¬ 
sensitive persons, may have contributed to the superstition. 
Acid foods served with milk foods have been objected to on 
the theoretical ground that milk curdles with acid; the fal¬ 
lacy is obvious when one remembers that milk is expected to 
curdle before digestion anyway, and that except in babies it 
would do so from the acid of the stomach. Acid and alkaline 
drinks are criticized because they alter the stomach’s acidity, 
but while acid is required for peptic action on meats its exact 
concentration is of no importance; some persons in apparent 
health have acidity much above the average and others much 
below. Drinking of water with meals is objected to, but as a 
matter of fact digestion proceeds much better if a lot of 
water is mixed with the foods; unless the water serves to 
wash down the foods and hasten the eating it does no harm. 

Digestive Juices.—The first trace of digestive activity is 
that of saliva on the starches. No considerable degree of 
digestion takes place until other juices have been added in 
the stomach. The final quota of juices reaches the mass in 
the first part of the small intestine. 

The sources of digestive juice are secreting cells, derived 
from the epithelium within the tract. Some of the cells are 
in the membrane of the stomach, others in that of the intes¬ 
tine, and others in distinct glands which have developed from 
outgrowths of epithelium. Such glands are those about the 
mouth which secrete saliva, and that in the abdomen known 
as the pancreas. The latter is a large gland which empties 
its juice through a duct into the small intestine. Bile enters 
at the same place from the liver, and while not itself digestive 
it aids the activity of digestive juices. 


108 


THE FOUNDATION OF HEALTH 


The digestive glands and the liver require no attention to 
keep them active, other than general alimentary hygiene. 
So-called liver medicines have often been employed by con¬ 
stipated persons to correct that organ’s supposed sluggishness, 
but the liver is not the organ affected by these medicines nor 
was its sluggishness a cause for the constipation. Constipa¬ 
tion will be considered shortly. The action of the respective 
juices will be explained later in connection with foods and 
nutrition. 

Bacterial Flora.—The question has been raised as to whether 
ferments from bacteria may not also aid in the digestion of 
foods. The bowel contents swarm with bacteria, of which 
many secrete ferments capable of acting on the food matter 
about them. These bacterial ferments have sometimes been 
thought necessary to the digestive function; the evidence is 
conflicting. At all events these bacteria are in no sense harm¬ 
ful, and nothing would be gained by the routine taking of so- 
called intestinal antiseptics, even if they worked. Only 
rarely, in the physician’s management of certain disorders, 
is antisepsis of the bowel to be desired. 

Absorption.—When foods have finally been digested, the 
mucous membrane of the small bowel absorbs them and passes 
them through to the vessels beneath. Some epithelial cells 
of the membrane have the specialized function of taking in 
the nourishing solutions; this is facilitated by the normal 
peristaltic action, which moves the mass slowly along and 
keeps squeezing the membrane into it. The small blood- and 
chyle vessels, which richly supply the submucous coat, send 
tributaries to the epithelial cells of the mucous membrane 
to collect the absorbed material. 

Foods other than fats are passed directly to small blood¬ 
vessels. The fatty matter absorbed, called chyle, passes into 
the chyle vessels, which form part of the lymph vessel system. 
Smaller chyle vessels converge into the larger, and the last 
empty into the large veins. Through these channels all the 
food absorbed gets to the blood stream and is distributed to 
the tissues. 

Blood Supply.—The intestine uses an especially full supply 
of blood during the process of digestion. This should be 


THE DIGESTIVE SYSTEM 


109 


carefully provided for in the case of underweight persons or 
those having some other physical defect. The malnourished 
are benefited by lying down for an hour or two after meals, 
so as not to draw away the blood to working muscles. Any 
persons with circulatory defects might well abstain from bath¬ 
ing or swimming during this period of digestion, as such 
interference with the distribution of blood could easily strain 
the circulation. 

The work of the brain does not draw actively on the blood 
supply of other organs, but must get along with what they 
are not using; great accumulation of blood for digestive pur¬ 
poses therefore draws blood from the brain and retards 
mental activity. On a hot day, when the skin is also drawing 
on the blood supply, a drowsiness and lagging of mental 
activity is quite likely to follow a heavy meal. Many take 
their heaviest meal at night in order to permit closer mental 
application during the early afternoon. 

Absorption of Chemicals.—The membrane which absorbs 
food to the blood stream can absorb simpler chemical solu¬ 
tions too, in many instances much more readily. The absorp¬ 
tion of medicinal drugs is an instance, as unfortunately is 
also that of chemical poisons. The importance of teaching 
children to recognize and avoid poison bottles is obvious. 
Swallowing of poisons by adults is more often by accident 
than through ignorance of the danger; carelessness about 
labelling or reading the labels is often at fault. Proper 
labelling of home-made solutions is very often neglected, and 
poison labelled by the druggist is taken in the dark. Such 
carelessness has led to many deaths. 

Dishonest labelling is a factor in the patent medicine hazard 
to health. Mixtures which contain stimulants to exhilarate 
the victim or other drugs to deaden his sensibilities alleviate 
discomfort only temporarily, but their labels and advertise¬ 
ments are so worded as to suggest a permanent relief. False 
hopes are given to unfortunates who might otherwise accept 
what aid medical care can give and use their own resources 
to some advantage. What medicinal activity the patent 
medicine has at the seat of injury is often detrimental rather 
than helpful. A large number contain cathartic drugs which 
aggravate a constipation and make the complaint worse. 


110 


THE FOUNDATION OF HEALTH 


First Aid to the Poisoned.—Every one should know how to 
manage cases of accidental poisoning, for often a patient must 
be either saved or lost before a doctor can be reached. First 
aid consists in immediately giving an antidote, and then, 
except for mineral acid or alkali, emptying the digestive tract. 
Vomiting may be induced by a drink of warm mustard water 
—a tablespoonful of mustard to a glass of warm water. 
After the stomach has emptied itself and quieted down, an 
active cathartic should be given. Taking of the antidote 
may be repeated occasionally throughout the rest of the 
process. Except in the case of opium poisoning, the patient 
is to be kept warm, rested, and given plenty of water. 

It is hardly worth while for average people to learn 
what antidotes they might get from the druggist, because 
the druggist would know which is best for the case in hand. 
It is decidedly worth while to know what antidotes are in the 
kitchen, which is so much nearer than the drug store. Mineral 
acid poisoning may be treated by the eating of soap; a few 
teaspoons of magnesia is better, but this is not often at hand. 
Soda is not a safe antidote for acids taken internally, as 
the gas liberated would tear the eroded tissues. Lye or other 
alkalis are neutralized by dilute vinegar. For heavy metal 
salts, such as mercury bichloride and arsenic preparations, 
milk or egg albumen is given. Strong tea binds and makes 
harmless the aikaloidal drugs, such as strychnine, atropine, 
and many others with a name ending in rt ine.” Starch 
binds iodine; while preferable cooked, it is better to give it 
raw than to wait for cooking. Carbolic acid is best counter¬ 
acted by an alcoholic drink, if a stomach tube is available 
for cleaning out the stomach—the most important item in 
this instance—though not otherwise. Chalk or plaster is 
used for oxalic acid, soda for the coal tar drugs in headache 
powders, and strong tea or coffee after morphine or other 
opiates. In the case of opium poisoning, the patient is to 
be kept aroused and awake at any cost. In any case of 
poisoning one should work fast; deliberation is likely to prove 
more costly than minor mistakes. 

Bacterial Food Poisoning. -Food poisoning is a general term 
applied to any of several acute disturbances which result 


THE DIGESTIVE SYSTEM 


111 


from the ingestion of unwholesome food preparations. The 
term ptomain poisoning is often used as a synonym, though 
properly this term should be restricted to the rare cases of 
poisoning with certain protein decomposition products 
called ptomains. Bacterial poisoning of foods is principally 
of two types, acute enteritis and botulism. 

The commonest type of poisoning is one of the food-borne 
infections; the other food-borne infections are not popularly 
termed poisoning and are not included. This form of “ poison¬ 
ing” is an enteritis, often suffered epidemically by several 
persons who have eaten together. An acute diarrhea with 
vomiting, abdominal cramps, and some feverishness, follows 
the feast usually by something less than a day. This is due to 
an intestinal infection by certain bacteria ( Gartner's and allied 
bacilli). The bacteria reach the food occasionally as a con¬ 
tamination, during or before preparation, but more commonly 
as an infection of the animal slaughtered for food. The 
germs are not readily destroyed even by heat, and to be safe 
the infective meat must be cooked until well done throughout. 

Botulism.—Botulism is poisoning due to one of the bacterial 
toxins (of Bacillus botulinus ); this is the only bacterial toxin 
which has been shown to be poisonous when taken by mouth. 
The bacterium enters canned or preserved foods through 
dirty handling by canners; as its growth requires no oxygen, 
it continues to multiply in the sealed receptacle and to throw 
off into the food its toxin. The symptoms are nervous rather 
than intestinal. Instead of diarrhea and cramps, dizziness is 
complained of, with nausea, difficulty in eating, and marked 
prostration. Double vision, dilation of the pupil, and droop¬ 
ing of the lids occurs. This is much more serious than the 
other type of bacterial poisoning, and is often fatal. Cleanli¬ 
ness in putting up foods is a preventive, as is also the heating 
to an almost boiling temperature—above 80° C or 176° F. 
for half an hour—before serving; this degree of heat breaks 
down the toxin. If canned goods that smell or taste some¬ 
what spoiled are to be eaten at all, it is safer to heat them first. 

Other Food Poisoning.— A few naturally poisonous sub¬ 
stances closely resemble foods and therefore lead to poisoning. 


112 


THE FOUNDATION OF HEALTH 


Several poisonous plants and certain poisonous fish resemble 
edible articles, though most of them are unlikely to be offered 
for food in this country. Poisonings with marked nervous 
involvement have occurred from eating mushrooms. Mush¬ 
rooms should be collected only by those who are able to dis¬ 
tinguish wholesome varieties from those which contain 
muscarine and other poisons. The poisoning of foods by 
metallic products from pots and pans occurs less often than 
was formerly thought; many apparent cases of this are 
really food infections. 

The preservative addition of those antiseptics which the 
authorities condemn as injurious might almost be classed with 
the criminal poisoning of foods, but it occurs. In some locali¬ 
ties the treatment of market milk with formalin to delay sour¬ 
ing is widely practised, and for babies or possibly some older 
persons such milk is not always harmless; heating in a pan 
rids milk of the bacterial danger but a chemical poison in 
milk is beyond correction. Such preservatives as benzoate 
of soda, used to permit slowly perishable foods to be used 
over considerable periods of time from open containers, are 
not injurious in any proper concentration; overdosage of the 
food with the antiseptic, practised sometimes to check a 
decomposition which has already begun, is more likely to 
do harm. 

Large Bowel.— The large bowel receives from the small 
bowel the food roughage, from which nutritious elements 
have been absorbed. Vegetable fiber, bacteria, and other 
matter which is not nourishing, is mixed with water to a 
thick liquid consistency. The large bowel functions by 
taking out much of the water and leaving the food waste more 
solid. The absorption of the water is attained by continued 
passage and repassage of the material over the membrane. 
In the first part of the large bowel peristalsis in the reverse 
direction ( anti-peristalsis ) keeps sweeping back toward the 
closed upper end, and water is gradually taken out and into 
the blood stream. When sufficiently dried of excessive 
moisture, a downward peristalsis carries the material along. 
The downward propulsion in the lower bowel is stimulated 


THE DIGESTIVE SYSTEM 


113 


by the mechanical pressure of this material and by the chemi¬ 
cal action of some constituents. 

Constipation.— A moderate amount of semi-solid material 
is normally carried; an increase in this amount stimulates 
the nerve ends, and through them peristalsis. If the food 
eaten is chiefly nourishing and has little bulk, that which 
reaches the lower bowel is insufficient to stimulate movement. 
This results in constipation, the most frequent disorder of 
the tract. A tendency to constipation seems sometimes to 
be inherited, together perhaps with a sagging of the viscera, 
and sometimes to result from such uncontrollable disorders as 
chronic appendicitis. More common factors are within our 
control; among these are improper diet, worry, irregularity 
of habit and chemical catharsis. 

Catharsis Futile attempt is often made to remedy an 
inactivity of the bowel by the use of cathartics. We will 
here employ the term cathartic in a limited sense, to include 
all the classes of active drugs which cause bowel movement. 
Castor oil, cathartic salts, and cathartic pills have a very wide 
sale as remedies for constipation. Their action is by an 
excessive stimulation which tends to empty the lower bowel. 
This tires out the nerve-muscle mechanism and for a period 
removes all the pressure stimulus of the contents. Con¬ 
sequently, the action is afterward more sluggish and the 
constipation more pronounced than at the start. 

A tendency to constipation becomes progressively worse 
under treatment by cathartics. The normal bowel will 
stand a certain amount of catharsis without injury, but the 
constipated bowel is one with an already weakened function¬ 
ing power and the cathartic further impairs it. Large water 
or soapsuds enemas empty the lower bowel just as cathartics 
do, and are followed by corresponding periods of constipa¬ 
tion. The habitual so-called “internal bath” is anything 
but a hygienic device. 

Diet for Constipation .—The logical management for con¬ 
stipation would be of just the opposite type. The bowel’s 
operation should be helped into its natural state. An increase 
of bulk foods brings back the normal stimulation by pressure. 
The coarse foods, such as potatoes, greens, and other vege- 
8 


114 


THE FOUNDATION OF HEALTH 


tables which are rich in fiber, are to be substituted for such 
highly nutritious foods as eggs, sweet milk, and meats. The 
objection to this latter group of foods is that they take away 
the appetite for coarser ones. Bread and butter in large 
quantity provides bulk and is desirable. White bread has 
considerable bulk, rye bread more, graham bread still more, 
and bread containing bran the most of all; their anti-constipa¬ 
tion value ranks accordingly. The only chemical stimulants 
to be desired are those in ordinary foods, such as buttermilk 
and cooked or raw fruits; the acids of these foods are laxative, 
but too mildly so to do harm. 

Other Measures Except in babies, the pressure by abdom¬ 
inal muscles plays a major part in the movement of the 
bowel. General physical exercise, or special exercise or 
massage of the abdominal muscles, counteracts a sluggish¬ 
ness of the bowel. Exercise also serves as a relief from worry, 
and improves the appetite for coarse foods. In all these 
directions it combats the tendency to constipation. Evacua¬ 
tion of the bowel at a regular time each day is another aid. 
Forced drinking of water adds moisture to the body fluids, 
and prevents their taking out so much water from the con¬ 
tents of the large bowel; this counteracts constipation. 

If temporary relief must be sought, a simple oiling of the 
large bowel is the least objectionable means; this lubricates 
and to some extent checks the drying out of the bowel con¬ 
tents. Olive oil or some cheaper vegetable oil may be used 
as a retention enema, a few ounces being retained overnight. 
If taken by mouth the vegetable or animal oils would for 
the most part be absorbed as nourishing food before reaching 
the large bowel. Mineral oil {liquid petrolatum: paraffin oil), 
on the other hand, is not absorbed to the system and passes 
unchanged into the large bowel; it tends to relieve constipa¬ 
tion when taken by mouth. Several ounces daily may be 
required for any effect. Glycerin suppositories irritate only 
the lowest stretch of bowel and are less objectionable than 
the cathartics, which would irritate a larger part of it. 

Infants’ Constipation.— For babies, about a teaspoonful of 
malt soup extract mixed into the daily feeding is usually 
sufficient to combat any tendency to constipation. Inactivity 


THE DIGESTIVE SYSTEM 


115 


of the bowel for more than a day with babies calls for reliev¬ 
ing measures, though active chemical catharsis is quite as 
bad or worse for infants and children than for older people. 
Use of the infant’s size glycerin suppository is as practicable 
and much less injurious. If suppositories are given repeat¬ 
edly, this should be at a regular time each day in order to 
help reestablish a regularity of movement. 

Diarrhea.— Diarrhea is frequently a symptom of some 
general disease, and unless it tends shortly to subside should 
have the underlying cause determined by a physician. The 
diarrheal condition means that the bowel is being over¬ 
excited, and for recovery it needs a rest from this excessive 
stimulation. Avoidance of bulk foods eliminates much of 
the stimulus to excessive action. Any of those foods which 
excite peristalsis retard recovery, and are to be discontinued 
until the condition is corrected. 

During the very acute stage the best diet contains nothing 
more irritating than a strained gruel, taken in small amounts 
every hour rather than in larger amounts at meal-time. As 
the condition begins to improve, boiled milk is gradually sub¬ 
stituted for the gruel. As the diarrhea stops other foods are 
added. In addition to the changes in diet, it is important 
that the patient remain in bed and during a major part of the 
time keep a hot-water bag to the abdomen. 

Infants’ Diarrhea.— Diarrhea in babies is managed along 
similar lines. The regular feedings are discontinued for a 
while, and instead of them only water or barley water is 
given. As the condition improves, the feedings go back to a 
weak dilution of milk, at first boiled. Sugars are withheld 
until the diarrhea entirely stops; saccharin—one grain to 
the quart—may be employed as sweetening if the baby 
refuses fluids otherwise. The largest possible quantity of 
water is to be given the baby with diarrhea, for the gravest 
danger is created by a drying out of the tissues due to loss of 
the fluid discharged. It is never safe to take chances wi th 
an infant’s diarrhea, and anything w T orse than the mildest 
and most fleeting of attacks should be referred to a physician. 
Preventives of diarrhea in infants, particularly of the serious 
summer diarrhea, are discussed in a later chapter. 


116 


THE FOUNDATION OF HEALTH 


Reading.* 

General, Winslow, Chapter II. 

Physiology of the Digestive Tract, Hough and Sedgwick, 
Chapter VIII. 

Absorption of Food, Mathews, Chapter XI. 

Nervous Mechanism of Stomach, etc., Harvey Lectures, 
1915-16, Lecture by A. J. Carlson. 

Treatment for Poisoning, Pyle, Appendix. 

Constipation, Fisher and Fisk, Chapter III. 

Constipation in Babies, Grulee, Chapter XIII. 


* See bibliography for titles and publishers of books. 


CHAPTER VII. 


RESPIRATION AND BODY HEAT. 

The Lungs.— The mucous membrane in the lungs passes 
oxygen into the system, and passes from the system such 
body waste as assumes gaseous form. It forms into sacs, in 
which the air is being constantly renewed and freshened so 
as to maintain a high concentration of oxygen; some of the 
oxygen passes on through to the bloodvessels beneath. 

The air sacs open into the smallest of the windpipes 
( bronchioles) and these converge into larger ones ( bronchi ); 
the latter open to the exterior through the crooked passage 
to nose and mouth. As the chest cavity expands in breathing, 
it sucks in outside air, and as it reduces it forces out some 
of the air contained. The system of branching windpipes 
and air sacs is the lower respiratory tract, and the crooked 
passage to the exterior is the upper respiratory tract. 

Absorption of Gases.— Gases other than oxygen likewise 
pass through the membrane. Some of the anesthetics, as 
well as certain other medicines, are introduced to the tissues 
through this route. An instance is the volatile amyl nitrite, 
which is breathed in to quiet the spasms of angina pectoris. 
Poisonous gases enter similarly, and unfortunately the most 
poisonous are not those which would be avoided because of a 
bad odor. Odorous gases of decomposition are not injurious, 
whereas some gases with a pleasant odor are very much so. 

Poisoning occurs from zinc fumes among brass workers, 
from benzol fumes among workers with dyes and some rubber 
preparations, and more acutely and seriously from carbon 
monoxide under many conditions. It is prevented only by 
avoidance of the fumes. Coal gas, or other mixture contain¬ 
ing carbon monoxide, so changes the hemoglobin in the red 
blood cells that these cannot carry oxygen to the tissues. 


118 


THE FOUNDATION OF HEALTH 


Carbon monoxide has no warning odor, though fortunately 
the mixed gas which contains it often does. The smell of 
illuminating gas warns people away; so does that of sewer gas, 
which at times becomes injurious from a leakage of gas into 
it. A person who has been overcome by a gas should be 
carried or dragged to a place with good air supply, and given 
artificial respiration. 

Artificial Respiration.— Artificial respiration is the principal 
first-aid measure for those who have stopped breathing 
because of electrical shock or drowning, as well as for those 
poisoned by a gas. Aeration of the lung membrane can be 
brought about by any of several methods of manipulation. 
A good one for general use is that of Schaefer. 

The patient is laid face down on the ground or floor, his 
arms extended above the head, and one elbow crooked to 
support the head. The manipulator straddles the patient 
over the thighs and pushes in hard on the lowermost ribs, 
resting his weight on them; releasing the hold, he allows the 
chest by its elasticity to expand and suck in a little air. 
The pressure and release is repeated about twelve times a 
minute until the patient himself breathes. This method 
works not only the muscles of the chest wall but also 
the main breathing muscle or diaphragm, a muscular sheet 
separating chest from abdominal cavities. 

Normal Breathing.— The relaxed diaphragm during expira¬ 
tion is drawn upward, and during inspiration its flattening 
contraction enlarges the cavity of the chest. Shallow breath¬ 
ing may be almost entirely by this muscle; deep breathing 
calls on the muscles of the chest wall as well. A mere forcing 
of the action of these muscles can be but a brief breathing 
exercise by one at rest, for the excessive oxygen absorbed 
excites to faintness or dizziness. Strenuous muscular work 
is better as a deep breathing exercise, for tissues at work 
utilize more oxygen and to supply them a breathing center 
in the brain deepens the respiration. 

Habitual shallow breathing does not greatly affect the 
lungs. It allows the membrane of the upper portion of each 
lung to collapse, and in this collapsed condition the lung 
tissue is sometimes thought to be attacked more easily by 


RESPIRATION AND BODY HEAT 


119 


tuberculosis. This condition is not, however, a major factor 
in the causation of tuberculosis; athletes who breathe deeply 
are not infrequently among those attacked by this disease. 
Deep breathing fills the entire lungs with air, to which it 
opens up all of the many yards of membrane, and this might 
possibly add to the resistance of the lungs. Deep breathing 
should be encouraged even if it did not affect the respiratory 
system at all, for it benefits posture and other functions of 
the body. 

Hiccough.— Hiccoughs are spasms in the diaphragmatic 
muscle. They are sometimes caused by inflammatory dis¬ 
ease about the muscle or about its nerve supply, and some¬ 
times much more harmlessly by temporary conditions in the 
stomach or even as a habit spasm without assignable cause. 
The relief occasionally to be obtained from a large drink of 
water, or that from a forced discontinuance of breathing 
motions for a time, is familiar to all. Hiccoughs which persist 
obstinately for days suggest the more serious causes. Inflam¬ 
mation which spreads extensively about the abdominal 
cavity (general peritonitis), and that which involves the 
brain (encephalitis), are among the diseases likely to have 
this as a symptom. Ordinary hiccoughs in the baby result 
from the overfilling of the stomach with food and air, and 
stop when part of the material passes on into the bowel. 

Upper Air Passages.— The upper respiratory tract includes 
the nose, sinuses, throat, mouth and larynx. The passage¬ 
way through these organs admits air to the lungs and cleans 
and warms it in passage. It is lined throughout with mucous 
membrane, which is kept warm by a rich blood supply and 
kept wet and sticky by mucus from its glands. Wet and 
crooked tubes all tend, by catching dust on their walls, to 
clean and sterilize air passing through. 

Obstruction to Breathing.— A septum separates the left 
from the right nasal cavity, and shelf-like protuberances 
(turbinates) extend into the respective cavities from their 
outer walls. These structures increase the extent of mem¬ 
branous surface over which the air current must pass. If 
normal, they facilitate the warming and cleaning of the cur¬ 
rent, but if deformed from faulty development or accident, 


120 


THE FOUNDATION OF HEALTH 


they impede this current in passing to the lungs. The septum 
may be bent ( deflected ) or the turbinates enlarged, and these 
defects close either partially or wholly the nasal cavity. 
Another common site for obstruction is just behind the nose. 
Growths of lymphatic tissue ( adenoids ) often develop in the 
top of the pharynx and close the opening from the nose. 
In children, the tonsils sometimes enlarge into a partial 
obstruction. 


NOSE- 



MOUTH 


THROAT 



TO 

STOMACH 


Fig. 15.—Upper air passageway. 


Obstruction in the nasal passageway forces more of the 
current to the mouth; breathing may be through the mouth 
entirely. This involves a poorer cleansing and warming of 
the inhaled air, and it interferes with the quality of the voice. 
Dryness about the mouth and throat may result, causing 
at the time a bad taste and more remotely a catarrhal inflam¬ 
mation. A consequent interference with hearing may ensue. 
Constant and continued mouth-breathing by children alters 
the bony growth and deforms their faces. Partial obstruc¬ 
tion tends to broaden the bridge of the nose and complete 
obstruction to narrow it. The expression becomes stupid, 
and in some cases an actual depression of mentality results. 
Permanent obstructions should by all means be removed 
surgically. 









RESPIRATION AND BODY HEAT 


121 


Smoke and Dust. —Smoke and dust reach the lungs with 
inspired air, due to imperfect cleansing of the current in the 
upper passages. Mouth breathing makes matters worse, 
though in no one can the smoke and dust of a dirty city be 
kept from the lungs. The lung tissue of city dwellers is 
blackened by the smoky air until a gray mottling replaces 
the uniform pink which characterizes the lungs of country 
people. Fortunately, the mottled lungs function just as 
well as the pink, and seem no more prone to disease. The 
smoke is a nuisance because it soils so many other things 
besides the lungs, and because it shuts off part of the sunlight. 

Many of the dusts on inhalation prove to be less harmless 
than smoke. Dusts hard and sharp enough to scratch the 
membrane of the lung favor the development of tuberculosis. 
Men who work in the dusts of stone, metals, and ore have a 
much higher tuberculosis-rate than those working in the 
softer dusts of coal, wood, starch and soil. Granite cutters 
have a high rate. Coal miners in properly ventilated mines 
do not, though there is a predisposition to milder respiratory 
disorders. 

Inhaling of Bacteria. —A second factor in the causation of 
respiratory disorder by dusty air is the bacterial contamina¬ 
tion of the dust particles. This has been suggested as a 
reason why persons engaged in dusty indoor occupations have 
a relatively high rate of respiratory disease. The membrane 
offers little resistance to the many infective agents that enter 
with the dust or spray in the air. That of both the upper and 
lower tract is susceptible to much infection, and it permits 
other infection to pass through without itself being inflamed. 

Infections of the lungs themselves do their greatest damage 
to functions other than respiration. The respiratory mem¬ 
brane is so extensive that a large part may be thrown out 
of function without any great effect on the supply of oxygen 
to the blood. 

Pneumonia.— The circulation is the function most seriously 
endangered by an attack of lobar pneumonia. Great por¬ 
tions of the lung tissue are solidified by the inflammation 
and this impedes the freedom of the blood’s flow; there also 
are other factors of strain on the heart. The resistance to 


122 


THE FOUNDATION OF HEALTH 


pneumonia is lowered by alcoholism, age, chilling, or other 
infections, and any control of these influences reduces the 
risk of death from pneumonia. Some degree of specific 
immunity can be acquired through anti-pneumonic vaccina¬ 
tion, and this also would reduce the hazard somewhat. The 
germ of pneumonia, or pneumococcus, has already been 
alluded to, as has also the distinction between lobar pneu¬ 
monia and bronchopneumonia. 

Tuberculosis.— Tuberculosis is the commonest of respiratory 
infections. The germ, tubercle bacillus, attacks and produces 
demonstrable small lesions about the lungs of practically all 
civilized people. Those whose resistance to the germs falls 
very low develop consumption. Loss of weight, afternoon 
feverishness, sweating at night, obstinate though perhaps 
mild cough, or the coughing up of blood suggests that one’s 
resistance may be giving way. None of the symptoms have 
this significance necessarily, but if they persist it is a possi¬ 
bility which should be looked into. 

Treatment or prevention is by nursing up general resistance 
to limit the lesions. Good nourishment, open-air life, regular 
habits and the avoidance of worry and fatigue are the main 
items. Public measures aim to reduce the extent of the gen¬ 
eral exposure to tubercle bacilli, as well as to build resistance 
in individuals. The authorities try to keep active cases 
away from children, whose resistance is likely not to be high, 
and to have the cases whose expectoration is most infective 
go to sanitaria. Free dispensaries refer cases to the sanitaria 
and teach people how to build up their resistance and protect 
others by guarding the expectoration. The greatest activity 
is needed in congested districts, where the prevalence of tuber¬ 
culosis is highest; the rate in down-town lodging-house and 
factory wards is perhaps twice a city’s average, and that in 
the better residence wards, half. 

Respiration.— Functionally, the respiratory system is con¬ 
cerned with the provision of energy for life processes. The 
supply of energy comes primarily from the sun, in its rays. 
The green matter ( chlorophyl ) in plants absorbs some of the 
rays and builds them into the plant’s constituent carbo¬ 
hydrates. Animal tissues acquire their warmth and other 


RESPIRATION AND BODY HEAT 


123 


energy by burning the carbohydrates and getting out the 
energy stored in them. As the enveloping air greatly retards 
the passage of heat, their warmth does not immediately 
leave them. 

The air has two properties which are essential to life. It 
holds in the heat, which is necessary for the functioning of 
tissue and which without the surrounding air would at once 
leave the body. It also supplies oxygen for the burning of 
food in the tissues; burning is the combination of a material 
with oxygen. This process is known generally as combustion; 
in the body it is known also as internal respiration. The 
designation as internal is to differentiate it from the breathing 
function, which is called external respiration. 

The red blood corpuscles form a means of feeding oxygen 
to the tissues, their red matter ( hemoglobin ) being capable of 
holding oxygen in loose chemical combination and later of 
giving it up. Oxygen is so concentrated in the network of 
bloodvessels beneath the mucous membrane of the lung that 
it forces itself into the red matter of these cells as they 
pass. It later diffuses from the red cells into the fixed tissues, 
being drawn by the much lower concentration there. Tissue 
cells retain the oxygen, together with sugars and other fuel 
food, until a combination of the mixture is needed for produc¬ 
tion of energy. 

Vital Energy.— When any fuel unites with oxygen, heat 
and power are evolved. Tissues get their power from the 
burning of fuel foods, just as motor cars do from the burning 
of fuel gas. The latter mixes with oxygen in the carburetor, 
and the mixture goes into the cylinders where it is lighted 
by an electric spark and combines, to give power to the car. 
Combustible foods which have entered the body through the 
digestive membrane mix in the tissues with the oxygen 
brought by the red cells. When contraction of muscle is 
called for, a nervous impulse sets off their combustion. Out¬ 
side the body a much higher temperature would be required 
for such combustion as takes place in the tissues, and how 
this can occur at the lower temperature is not clearly under¬ 
stood. Intricate chemical reactions are involved. The final 
result is the same as if the process had been along better 


124 


THE FOUNDATION OF HEALTH 


understood lines; energy is liberated and the same material 
end-products as of an ordinary combustion. 

Carbon Dioxide.—Chief among the end-products is carbon 
dioxide. This is thrown off by the tissue in quantities pro¬ 
portional to the work done, and mixes into the fluids through¬ 
out the body. Though a waste product, it serves a useful 
purpose before its elimination; its presence in the blood 
controls breathing. When the content of carbon dioxide 
reaches a certain point one cannot hold himself from taking 
a breath, for at this concentration it stimulates a center in 
the brain to cause inspiration. Excess over this concentra¬ 
tion passes from the blood to air sacs of the lungs and is 
breathed out. 

Animal Body Heat.—The degree of body heat required for 
animal functioning varies within narrow limits. Though a 
great surplus of heat is taken in, the body function of heat 
regulation discards accurately the excess. The regulation 
is controlled from another center in the brain, which corre¬ 
sponds in function to the breathing center just mentioned. 
When the body temperature falls too low or rises too high, 
this center provides for an accumulation or elimination of 
heat. The temperature remains normally at about 100° F., 
a few degrees higher in some of the deep tissues and lower 
out toward the surface. The skin is about 98° F. where 
protected from external cooling, and where not so protected 
has a variable temperature, sometimes as low as freezing. 
The mouth temperature is about that of the protected skin, 
and the rectal temperature a degree or so higher; there is a 
normal variation of some two degrees among individuals. 
In infants, the temperature is a degree lower than in older 
persons. 

Fever— Fever indicates such derangement of the brain’s 
heat center that it regulates high. The management of fever 
is directed less at the heat producing tissues than at the 
regulating mechanism. The strain is taken off the latter 
by rest in bed, which also quiets the unnaturally active 
tissue changes; this is the most essential part of the manage¬ 
ment. If heat production needed to be cut down, the fuel 
foods would be reduced, but this is not the case. The regu- 


RESPIRATION AND BODY HEAT 


125 


lator determines how much heat is to be acquired by burning, 
and if the burning is not of fuel foods it must be of tissue 
substance. The modern diet for fever is not starvation, but 
as full feeding as the weakened digestive tract can stand. 

An active abstraction of the fever’s heat is sometimes 
employed, though only for temporary relief. Chilling the 
skin by a cold sponge or bath causes the heat to drop several 
degrees within a half-hour, but during the next half-hour the 
body heat comes back gradually to the point of nervous 
regulation. 

Control of Body Heat .—The governing center throws off 
the excess of heat from the skin. When the tissues become 
overheated, a greater part of the warm blood is brought into 
the cooled surface of the body; the skin flushes. The regu¬ 
lator in the brain needs a well cooled skin for its greatest 
efficiency; with this it can cool the blood as much as is 
required and to prevent overcooling can withdraw it again 
from the surface. 

Heat from the skin radiates to the cooler surroundings, 
and to a less extent is swept away by currents of air or 
absorbed by the evaporation of moisture. Vaporization of 
the sweat absorbs heat, in part that of the body. Loss of 
heat can therefore be promoted by three measures. The 
skin should have access to cool air or other surrounding 
medium, into which heat may radiate or be conducted. It 
should be swept by air currents, which promote evaporation 
of sweat and blow away the warm, sweat-moistened film 
next the skin. The air should be dry enough to vaporize 
the sweat rapidly. Cooling of the skin is not to be so extreme 
as to exceed the mechanism’s range of efficiency. The body 
cannot hold its required amount of heat against too great 
odds. 

The center accumulates what additional heat is needed 
through impulses that add to the burning of fuel by muscles. 
Shivering indicates that combustion is being speeded up for 
this purpose. In lower animals the mechanism also conserves 
its supply of heat in cold weather by the ruffling up of the 
hairy coats, to hold more still air. The analogous goose- 
flesh reaction in human skin is ineffective because the hairs 


126 


THE FOUNDATION OF HEALTH 


are too small. To compensate, man must use more intelli¬ 
gence; clothing is worn and houses are heated. 

Physical comfort supplies the only practicable index of a 
desirable amount of exposure. Clothing and the heating 
of the house should be made to afford the least quantity 
of warmth that permits comfort. Cooling to the point of 
discomfort does not promote health, though by gradually 
adding to the severity of exposure colder surroundings are 
made comfortable and hygienic. Delicate children in quite 
wintry open-air schools are comfortable and improve by the 
exposure, though they may be cold to the touch of someone 
coming from indoors. 



a b 

Fig. 16.—Fibers of (a) cotton; b, wool. 


Clothing.— Warmth of clothing, like that of the furs or 
feathers of lower animals, is afforded principally by the air 
between its fibers. This retards the passage of heat, just as 
does an enclosed air sphce in lightly built walls. Warmth in 
cloth depends more on the air held than on the fabric’s weight 
and substance. Loose meshed cloth holds more than that 
which is woven closely, and makes a warmer garment. Cool 
cloths are those without much air space in the meshes. 

Cotton is cooler than wool. As its fiber is flat and limp, 
the air is pressed from its meshes much more readily than 


RESPIRATION AND BODY HEAT 


127 


from about the elastic fibers of wool or silk. The two cloths 
of animal origin have stiff and elastic fibers; the wool fiber 
is coarsely cylindrical and has a scaly surface, and the silk is 
more finely cylindrical and smooth. The cotton blanket is 
woven to contain a good deal of air and is at first warm, but 
it loses much of its warmth on laundering because the air is 
pressed out. This is not so much the case with a woolen 
blanket, due to the stiffer fiber. For warmth, one selects a 
loose meshed woolen cloth. Silk can be made warm, but it 
usually has such close weave as to exclude too much of the air. 

Color of Clothing .—The color of clothing is a factor in hot 
weather. Dark colors absorb and radiate heat, and tend to 
pass to the body any excessive heat of the surroundings. 
Except on hot days, the color does not materially affect the 
warmth of a fabric. It is only in the outer garment, which is 
exposed to the light, that color has any influence on warmth. 
The reputation of red flannels for special warmth is unjustified 
and is said to date from a time when the red dyes obtainable 
assumed different shades of color in wool and in cotton; 
as such dye would have betrayed the presence of any cotton 
it was not used for impure woolens. 

The dark color of cloths used for winter clothing has less 
to do with warmth than with an unsoiled appearance. The 
keeping of white clothes attractive is something of a bother. 
Under ordinary conditions there is little hygienic argument 
for keeping every vestige of dirt out of clothing. The better 
record of white for cleanliness leads to its popularity for the 
uniforms of hospital internes and nurses. 

Underclothing .—Warmth is not such an essential quality 
for underclothes, except in very cold climates. It is better 
to depend on extra garments when out of doors and to avoid 
too much clothing in the house. The element of selection 
for underclothing materials has more to do with the absorp¬ 
tion of moisture from the body, and its ready evaporation. 
As moisture is first absorbed into the air spaces between the 
fibers, the loosely woven cloth absorbs it the best. The 
nature of the fiber affects the retention of moisture in the 
cloth. Wool fibers, being markedly hygroscopic, take up 
moisture from the air spaces and hold it. Cotton and linen 


128 


THE FOUNDATION OF HEALTH 


cloths, having the less absorbent vegetable fibers, allow 
readier evaporation of the moisture in them. If loosely 
woven they both absorb rapidly and dry out rapidly, and 
are the more efficient for the removal of perspiration from 
the body. 

Persons who sweat but mildly find cotton preferable as a 
rule, in an average climate of the temperate zone. Some 
are safer and more comfortable in woolens, particularly 
rheumatic persons and others who at times sweat profusely 
and are liable to injury from chilling. When cotton and linen 
become saturated, the moisture drips out and the garment 
clings to the skin. It then feels clammy and chills, for water 
conducts heat rapidly. Wool would retain the same amount 
of moisture, due to its less collapsible mesh and its absorbent 
fiber, and leave air space next the skin; it would not feel 
so wet. 

Shoes which retain moisture about the feet, in conjunction 
with cotton stockings, chill the feet of some people. Physi¬ 
cians not infrequently advise the wearing of woolen stockings 
during convalescence. Footwear should be such as to permit 
the feet to dry. Sandals do this best, but fabric and leather 
shoes are also good. These absorb moisture and give it out 
to the air currents. The dressing process of patent leather 
curtails this capacity, and patent leather shoes or rubber over¬ 
shoes are in this respect objectionable. 

Ventilation.—Ventilation of the house might at first glance 
appear to influence chiefly the breathing requirements, but 
it has a much greater influence on the body’s regulation of 
its heat. The air’s content of oxygen and carbon dioxide is 
modified but slightly by poor ventilation. The air has about 
20 to 21 per cent of oxygen, and several per cent less is ample 
for respiration; slight quickening and deepening of the breath¬ 
ing easily compensates. Crowding in a badly ventilated 
room does not reduce the oxygen nearly this much. 

Moderate excess of carbon dioxide in the air is also harm¬ 
less; the content could not rise to more than a small fraction 
of 1 per cent, and in certain industrial work a content higher 
than 1 per cent proves to be associated with no discomfort 
or ill health to anyone. Carbon dioxide and an undefined 


RESPIRATION AND BODY HEAT 


129 


“crowd toxin” have at different times been thought harm¬ 
ful, but neither these nor other exhalations from a normal 
body would in any ordinary concentration be poisonous. 
Neglect of the ventilation of a room affects the quality of the 
air for breathing purposes only if illuminating gas or other 
poisonous fumes have leaked in. 

On the other hand, ventilation influences greatly the regu¬ 
lation of body heat. The air of the house should be cool 
enough to promote a radiation of heat from the body. It 
should be sufficiently dry to vaporize sweat, though not so 
excessively dry as to parch the skin and membranes. It 
should be stirred into such currents as will sweep away the 
warm film of water vapor which collects about the body. A 
badly ventilated room lacks air currents, and when crowded 
it assumes excessive warmth and moisture; all means for 
the loss of heat are then interfered with, and discomfort 
results. By ventilation is meant a provision of good air, and 
good air promotes heat abstraction. Other qualities of the 
air, as affected by ventilation, will be considered in other 
connections. 

Temperature.— In winter, the desirable temperature for 
sitting rooms is around 68° F. Most American people have 
accustomed themselves to a temperature of 70° F. to 75° F., 
which is too high for the best functioning in the average 
person. Other rooms need not be kept so warm, and the bed¬ 
rooms are better kept quite cool. Most persons do not have 
the resistance to rest comfortably in a bedroom with a tem¬ 
perature below freezing, but anything above freezing is 
usually tolerated by those used to it. Heating of houses 
will be considered more fully in connection with domestic 
hygiene. In summer, when the temperature rises until 
beyond control, the hygienic cooling of the body depends 
more on air currents. 

Circulation of Air.— In warm weather, the problem becomes 
almost entirely one of stirring up a breeze, by the open window 
or the electric fan. In cool weather the air currents play a 
smaller though still important role. They are produced if 
the heating units are installed near the floor, as the heated 
air rises and stirs up circulation. Introduction of outside 
9 


130 


THE FOUNDATION OF HEALTH 


cool air should be deflected upward, to create currents as it 
settles down. The exchange of the room's air content for 
outside air not only creates currents but also rids the house 
of fumes, odors, and perhaps dust or an excess of moisture. 

Humidity.— A very dry air leads to chapping of the skin 
and other discomforts; an excessive moisture on warm days 
retards the evaporation of sweat, and on cold days chills. 
A desirable humidity for the air is about 50 per cent of its 
capacity moisture, spoken of as relative humidity 50. Rela¬ 
tive humidity 100 would indicate the greatest amount of 
moisture which can be held in vapor form at that tempera¬ 
ture. When a fully saturated warm air is cooled, there is an 
excess of water vapor beyond this new capacity which con¬ 
denses, because cold air can hold less of the vapor than 
warm air. 

When cold winter air is heated, its capacity for moisture 
rises and additional water is required to approximate the 
desired relative humidity of 50. Evaporation of water from 
cans about the radiator or stove helps to make up the defi¬ 
ciency, though this does not nearly meet the full requirement. 
Rarely is there any means available for overcoming the dry¬ 
ness of the air in winter. 

By reference to standard tables, the relative humidity of a 
room is easily computed from the difference in reading 
between wet and dry bulb thermometers, swung about in an 
instrument made for the purpose. The evaporation of 
moisture about the one bulb cools it, the degree of evapora¬ 
tion and consequent cooling depending on the extent of the 
air’s dryness. 

Artificial Ventilation.— Devices for artificial ventilation 
are often necessary in theaters and other buildings where 
natural ventilation is inadequate due to the number of 
people who congregate in a limited space. As a rule these 
devices consist of mechanical fans. One method is to suck 
the air from the room (<exhaust method), another to pump air 
into the room (;plenum method), and a third to use fans acting 
in both capacities (combined method). In some ventilating 
systems the humidity is controlled, as well as the circulation 
and change of air; the current is passed through a chamber 


RESPIRATION AND BODY HEAT 


131 


moistened by a spray of water or otherwise. While artificial 
ventilation is frequently preferable for large buildings, 
natural ventilation is better suited to the home. 

Catching Cold.—It is difficult to say just what harm is done 
by overexposure to cold. Tradition, possibly with some 
justification, has associated affections of various parts of the 
body with such exposure. “ Colds in the head,” “ colds in the 
muscles,” and “colds in the joints” have been spoken of 
widely, the first so much so as to give it a clear title by usage 
to the term common cold. 

The common cold is an affliction of the upper respiratory 
tract, of which the cause remains obscure. A parasite of 
some sort plays a part, and the means of prevention is essen¬ 
tially the same as of other contagious diseases. The resist¬ 
ance to the parasite is probably associated, to some extent, 
with the heat regulating mechanism. A body whose heat 
function is made resistant by regular exposure to weather or 
cold baths is said to resist also the common cold. “Catching 
cold” would indicate that an unaccustomed chilling so 
strains this dual resistance as to permit colds to develop. 
The widespread assumption that a pleasant draught in warm 
weather exposes to colds, even though it does not chill, is 
certainly a mistaken one. 

The best management for a case of common cold is the 
avoidance of chilling and rest in bed. Home remedies for 
colds, which consist usually in proprietary nose sprays or 
pills, relieve the symptoms in some cases and make the colds 
more bearable. It is questionable whether they shorten the 
course at all. 

Heat Function in Childhood.—The heat function in child¬ 
hood, and especially in infancy, is much less stable than in 
later years. Ailments which would cause little fever in an 
adult may cause a high one in the baby or child; the amount 
of fever in children is often no index of the malady’s severity. 
The heat regulating center is in them quite easily deranged. 

The center also has a comparatively narrow range of effi¬ 
ciency. Extremes of temperature are not effectively resisted 
for the first few years, and exposure to pronounced heat or 
cold is unsafe. Delicate babies are sometimes given oil rubs 


132 


THE FOUNDATION OF HEALTH 


instead of baths, because of the tendency of the bath to 
chill. When the bath is used, it should approximate the 
temperature of the body. 

Overwrapping.—The care taken of the baby’s delicate 
heat regulating mechanism has often been scrupulously 
illogical. It has not been realized that excesses of heat must 
be eliminated, and that for this the mechanism needs a 
cooled skin. Bundling up of the baby is of value only when 
it protects from the cold. Such wraps as to make it perspire 
and fuss about in discomfort have nothing to commend 
them. Some people clothe the baby more warmly than they 
themselves could comfortably endure, and they argue the 
necessity of this for health maintenance. Too much clothing, 
as well as hot weather, causes prickly heat; the other effects 
may be worse. The severe and frequently fatal summer diar¬ 
rhea in babies is attributable largely to an inability to elimi¬ 
nate excessive body heat. 

Summer Complaint.—The occurrence of summer diarrhea 
(<summer complaint: cholera infantum: alimentary intoxica¬ 
tion) is in the period of very hot weather; there is a close 
relationship between the heat curve of the summer and the 
incidence curve of this complaint. It would appear that the 
heat itself is a causative factor. No opportunity for cooling 
babies during such weather is to be overlooked; they do not 
need clothing and they do need air currents. A gentle breeze 
from the electric fan is preferable to no breeze. The “colds 
from draughts” bugbear is largely responsible for the over¬ 
wrapping and underventilation from which so many babies 
have been made to suffer. Other causative factors of summer 
diarrhea are the use of poor grades of unpasteurized milk and 
of badly proportioned feedings; they combine with the heat 
to cause the affliction. 


Reading. * 

General , Fisher and Fisk, Chapter I. 

Mechanisms for Breathing and Heat Regulation , Hough and 
Sedgwick, Chapters X and XII. 


See bibliography for titles and publishers of books. 


RESPIRATION AND BODY HEAT 


133 


Respiration of Tissue, Mathews, Chapter XX. 

Food Fuel, Oxygen and Carbon Dioxide, Harvey Lectures 
1916-17, Lecture by J. S. Haldane. 

Disorders of the Respiratory Passage, Cornell, Section on 
Nose and Throat. 

Artificial Respiration, Lynch, Chapter VII. 

Heat Regulation, Woodman and Norton, Chapter II. 

The Tuberculosis Problem, Hill, Chapter XIV. 


CHAPTER VIII. 


FOODS AND NUTRITION. 

Foods.—A knowledge of the materials from which the body 
is built, and of the origin of the power it uses, must underlie 
any broad comprehension of nutritional hygiene. Body 
tissues are constructed from products of certain foods, and 
the power available to them is derived from the burning of 
these and other foods. 

The foods of man must include protein, carbohydrate, 
fat, and such accessory substances as vitamines, etc. Foods 
from which tissue is built are for the most part protein. 
Protein is the conspicuous ingredient of lean meat, eggs 
and fish. It differs from other types of food in containing 
nitrogen, and occasional other elements, in addition to the 
hydrogen, oxygen, and carbon, common to all. Sugars 
and starches after digestion are readily burned to supply 
heat and power to the body; these are among the carbo¬ 
hydrate substances in which organic nature abounds. Fat 
foods also supply fuel; they burn less readily than the 
carbohydrates but when burned give off more heat and 
power. 

Tissue Building.—Of primary concern is the formation of 
tissue from protein foods. Let us say that beef muscle, as 
meat, is to be converted into living human muscle. In order 
to pass through the intestinal wall and into the tissues, the 
meat must be dissolved and broken down; only the compara¬ 
tively simple derivatives of protein called amino-acids are 
assimilable. Crude proteins are extremely complicated in 
chemical structure, combining in themselves over a dozen 
different kinds of amino-acids; this union must first be broken 
by digestion. 

The processes necessary for breaking down these complex 
substances into assimilable form are such involved ones that 


FOODS AND NUTRITION 


135 


it is well nigh impossible to pass proteins to the tissues 
through channels other than the digestive tract. Direct 
introduction to the blood stream of a simple sugar supplies 
the tissues with fuel, but it is not possible in this way to 
furnish them an appreciable quantity of protein. Nutrient 
enemas of eggs and milk have been given to patients whose 
stomachs were thrown out of function by disease, though 
little is accomplished by this as the substances do not reach 
such parts of the tract as would digest and absorb them. 

Digestion of Protein.—Coagulation of protein is a prelimi¬ 
nary to its digestion. Cooking coagulates the albumens of 
meat just as it does egg white. Uncooked albumens are 
coagulated by the juice of the stomach, due principally to 
the hydrochloric acid there. Animals with a very strong 
stomach acidity, the dog for instance, do not show preference 
for cooked food. The subsequent digestive action is by 
several sorts of ferments, which are variously aided by the 
acid of the stomach and other materials. The complex 
protein must go through three distinct stages of dissolution 
in order to reach the form of amino-acids, and each stage 
requires a different ferment. 

The occurrence of the proteolytic ferments is largely in 
the following digestive juices: 

Proteins are broken down 

to peptones and then to interme- then to amino- 

proteoses diate products acids 


by pepsin and . . in the stomach 

rennin juice. 

. by trypsin . in the pancre¬ 
atic juice. 

. by erepsin in the intestinal 

juice. 


Assimilation.—The amino-acids pass through the wall of 
the small intestine to the blood stream, which distributes 
them to the body cells. After entering the cell, they unite 
again into a complex protein substance, similar perhaps to 
the muscle tissue which was eaten to supply them. The 
amino-acids derived from eggs, cheese, beans and other foods 








136 


THE FOUNDATION OF HEALTH 


can be rearranged by the body into the form of muscle, if all 
the kinds of amino-acid which constitute muscle are present. 
Gelatin is a protein which lacks some of the amino-acids which 
the tissues must have, and only in combination with other 
proteins would it be a tissue building food. 

Metabolism.— New protoplasm is continuously building 
up in the tissue, and the old breaking down. These changes 
are spoken of as tissue metabolism. There are factors other 
than the supply of foods which influence the building of 
tissue. The condition of malnutrition can be due not only 
to a lack of food products, but also to an impediment which 
hinders proper assimilation of the food products present. 
Systemic disease causes a malnutrition much greater than 
the reduction in food intake could account for. Conditions 
which disturb the metabolism of the body are of great 
diversity. 

One of the normal influences on metabolism is the reproduc¬ 
tive tendency inherent in tissue. Another is the action of 
internal secretions. Another is the action of certain rays of 
light. Some rays beyond the violet end of the spectrum 
penetrate in varying degree all the tissues of the body, though 
they do not pass as do visual rays through ordinary glass; 
the roentgen-ray is used to find fragments of glass in the 
body. Roentgen-rays and similar rays from radium react 
on the tissues entered and prove medically to aid tissue 
growth. The effect is so powerful as to require careful dosage; 
overdosage of roentgen-ray has led to cancer and other dis¬ 
order of the tissues. 

An excess even of sunlight is injurious in some forms of 
tuberculosis, in which proper doses would be helpful. Metab¬ 
olism of normal or diseased tissue is influenced to a definite 
degree by the ultra-violet rays in sunlight, unfiltered by 
glass. These rays are much nearer the visual spectrum than 
are those above mentioned, and have less penetrative power, 
but either directly or indirectly through their effect on the 
skin they do affect the deep tissues. Furthermore, they are 
necessary to the healthy metabolism of such tissues. This 
applies particularly during the vigorous growth of childhood. 
Lack of sunlight in babies appears to be a principal causative 


FOODS AND NUTRITION 


137 


factor of rickets. Since the rays of the sun which react best 
on tissue growth lie close to those which act on camera films, 
the stimulating effect of a light may be estimated as roughly 
proportional to its suitability for amateur photography. 

Urticaria.—One disturbance of metabolism consists in a 
peculiar reaction of the tissue to poorly assimilable tissue 
foods. Many individuals have this peculiar intolerance for 
some certain protein food, even when eaten in very small 
amounts. A disagreeable condition called hives, or urticaria, 
results, in which the skin breaks out with an intensely itching 
rash. Hives has resulted from the eating by susceptible 
persons of different varieties of shellfish, meats, milk, eggs, 
grains, berries or melons. The trouble is with the individual 
rather than the food, for all these foods are wholesome for the 
average person. Various mineral salts and other substances 
cause in those sensitive to them a rash corresponding in 
many ways to the protein rash of hives. The management 
is simply the avoidance of any poorly tolerated articles; 
medical assistance is often required to find which is the 
troublesome food. 

Tissue Waste.—Waste products thrown off in the course of 
the metabolic changes of tissue pass into the blood stream 
and are converted largely to urea by the liver. The kidneys 
excrete urea, as well as uric acid and other waste, to the urine. 
The painful joint symptoms in gout are due to an accumula¬ 
tion of protein waste, the proper elimination of which is pre¬ 
vented by the disease. Articular rheumatism and various 
other ailments have been erroneously associated with uric 
acid accumulation. Patent medicine advertisers capitalize 
popular misconceptions of this sort. 

Waste products find their way to some extent also into 
most body secretions and excretions other than the urine, 
though the amount so disposed of is too small to lessen appre¬ 
ciably the load on the kidneys. In cases of very pronounced 
disease of the kidneys, physicians attempt to produce addi¬ 
tional elimination through the sweat glands and bowel. 
Waste in gaseous form, less from the changes of tissue growth 
than from the burning of fuel, is eliminated principally from 
the lungs. 


138 


THE FOUNDATION OF HEALTH 


Fuel Food.—The nutritional function, in addition to the 
building of tissues, provides them with fuel to be burned for 
power. Power is generated in the body cells when the fuel 
foods unite with oxygen. This is energy metabolism, or the 
internal respiration previously referred to. The blood stream 
distributes fuel food to the tissue cells, just as it does the 
amino-acids. There is some burning of protein for the 
generation of energy, though other foods serve this purpose 
more conspicuously. 

The carbohydrates available for tissue fuel are those which 
can be absorbed into the system, namely the simple sugars 
and other carbohydrates which are convertible into simple 
sugars by digestive juices. Wood is a carbohydrate which 
produces heat on union with oxygen, but it is not a food 
because human juices cannot digest it. The animal and 
vegetable fats can be broken down and absorbed, so they 
similarly are fuel foods. Mineral oils cannot be broken by 
the human digestive process and therefore are not foods, 
but pass through the bowel unchanged. 

Carbohydrate.— Carbohydrate foods may be: (1) Simple 
sugars ( monosaccharides ) such as glucose and fruit sugar; 
(2) compound sugars ( disaccharides ) such as cane sugar, 
milk sugar and malt sugar, the molecules of which are com¬ 
binations of two simple sugar molecules, or (3) higher carbo¬ 
hydrates ( polysaccharides ) which are still more complex and 
appear unlike sugar. The higher carbohydrates include 
starches, abundant in such articles of diet as bread and pota¬ 
toes. They include also plant fiber or cellulose, abundant in 
greens and other coarse vegetable foods. Plant fiber cannot 
be broken down by human digestive juices, and when used 
as a food it constitutes the non-nutritious bulk, which is 
depended on to combat constipation. 

Digestion of Fuel Food.— Starches can be broken down by 
a starch-splitting juice, chiefly of the pancreas, into com¬ 
pound sugars. Compound sugars are broken down by sugar¬ 
splitting juices of the small intestine into simple sugars. The 
simple sugars are absorbed as such by the membrane. The 
bile in the intestine emulsifies and otherwise changes fat to 
facilitate its digestion and absorption. Pancreatic ferments 


FOODS AND NUTRITION 


139 


digest the fats into fatty acids and glycerin, both of which 
are absorbed through the intestinal mucous membrane to the 
chyle vessels, where they reunite into fat and as fat are passed 
on to the blood. 

Digestive activity which most largely prepares the fuel 
foods for absorption may be represented as follows: 


Starches are broken 


Fats are broken 


to compound su¬ 

then to simple 

to glycerin 


gars 

sugars. 

and fatty acids 


by amylase 


by lipase 

in pancreatic 
juice. 


by sucrase, mal- 
tase, lactase, 

etc. 


in intestinal 
juice. 


Glycogen.—The absorbed sugars are held in the liver, 
muscles, and other organs as glycogen, until needed by the 
tissues. Glycogen is a higher carbohydrate, built from 
simple sugar and convertible back into simple sugar when 
required for burning. Excessive sugar in the body fluids is 
itself in many ways toxic. The low sugar tolerance in dia¬ 
betes results from an interference with the formation of 
glycogen. The unconverted sugar which accumulates leads 
to inflammation of various tissues and eventually to a 
comatose condition and death. 

Recent discoveries have afforded a pancreatic prepara¬ 
tion—see paragraphs on Internal Secretions—which, when 
injected into the body, causes a conversion of sugar into 
glycogen and makes good the defect due to the disease. 
Unless such a conversion can be effected, the patient with 
diabetes must reduce the sugars and starches of his diet to 
minimal amounts. 

Storage of Fuel.—If a large excess of food is eaten, a por¬ 
tion goes through the bowel unabsorbed. The blood does, 
however, take in much more than the amount actually 
needed. Any surplus of sugar over that demanded for the 
activity of the tissue is changed into fat, and as such is 
stored in the fatty tissues. The surplus of fat taken in is 





140 


THE FOUNDATION OF HEALTH 


likewise stored there. When the supply of glycogen and 
sugar runs low, the fat is brought from storage to be burned 
by the muscles. When the fatty tissues are exhausted of their 
fat, the tissue protein itself is burned to produce energy. 
This brings the real period of starvation, when all the stored 
fuel is exhausted and the framework of the body is being 
broken up for fuel. 

Fuel Value.—The desirable amount of fuel food in the diet 
is proportional to the amount of energy required. Mere 
living consumes a dozen units of energy per pound of weight 
daily, and mild muscular work half as much more. The energy 
unit is the amount of heat which raises 1 kilogram of water 
1° C.; this is called a large calorie. Engines all consume an 
excess of fuel over the amount actually transformed into 
power, and usually we allow the body enough fuel to produce 
20 calories of energy per pound weight daily. If the person 
does hard manual labor for a day, he expends correspondingly 
more energy than when at study, and the desired amount of 
food per pound weight would probably have at least a 25 
calorie value. In childhood the requirement is higher. 

In normal persons the appetite approximates the caloric 
measure just suggested, and is a sufficient guide to proper 
quantities of food. An appetizing diet which maintains 
weight without piling on fat, and which provides such evi¬ 
dences of health as a good color and freedom from unpleasant 
symptoms, is acceptable without caloric computation. It is 
easy and sometimes worth while to compute the fuel value 
of a diet. Proportioning from the weight, while less sound 
than from height and weight or extent of body surface, is 
sufficient for practical purposes. 

Caloric Feeding.—The adult indoor worker is allowed 
each day sufficient food to produce a number of calories 
equal to twenty times the body’s weight in pounds. For 
instance, a person weighing 150 pounds gets 3000 calories. 
Reference to a caloric food table shows how many calories 
of energy each kind of food produces, and by adding up 
enough portions to total in fuel value 3000 calories, we arrive 
at an average normal ration. 

The proportion of this food which should be protein is 


FOODS AND NUTRITION 


141 


roughly constant, and amounts to about one-tenth. Tissues 
require fuel and they wear out in proportion as they are 
worked; this fraction of protein in the diet is needed to keep 
them in repair. The food which yields 3000 calories, there¬ 
fore, should contain an amount of protein sufficient to yield 
300 calories, or 2 protein calories per pound weight. 

In arranging the day’s diet, articles are first listed accord¬ 
ing to taste and other considerations to be given presently. 
Breakfast, lunch, dinner, and anything to be eaten between 
meals, are included on the one menu card. Opposite each 
item is entered the caloric value of the portion desired, this 
being estimated from the caloric value per pound as given in 
a standard table. Many of the recent works on nutrition 
append caloric tables. The caloric value of the protein 
content is entered also after each portion. The sum of all 
calorie amounts entered should be equal to the person’s 
weight times twenty; addition of all protein calorie amounts 
should total about one-tenth of the first sum. If the actual 
readings are too far away from those anticipated, the quan¬ 
tities of food should be changed. 

One’s estimation might begin somewhat as follows: 


An example. 

Size of 
portion, 
i pound. 

Calories 

per 

pound. 

Calories 

per 

portion. 

j Protein 
per cent. 

Protein 

calories 

per 

pound. 

Protein 

calories 

per 

portion. 

For breakfast: 

Pork sausage . 

\ 

2030 

254 

13.0 

! 260 

32 

Potatoes 

I 

4 

378 

95 

2.2 

44 

11 

Toast . 

1 

8 

1385 

173 

J 11.5 

! 230 

29 

Sugar for coffee, 
etc. 

j 







“Calories per pound’’ are stated in caloric tables, and 
“calories per portion” are i, etc. of the calories per pound, 
according to size of portion. “Protein per cent” or else 
“protein grams” or “protein calories” is stated in table. 
Many give protein figures in percentage rather than in calo¬ 
ries, in which case a rough but workable caloric value is this 









142 


THE FOUNDATION OF HEALTH 


percentage of 2000, as straight protein yields nearly 2000 
calories per pound. If the protein content is given in grams, 
the caloric figure is four times this, as each gram of protein 
yields 4 calories. “ Protein calories per portion” are the 
proper fraction of the figure in the preceding column. Only 
the two columns giving “calories per portion” and “protein 
calories per portion” respectively are to be added. 

Adulteration.—Adulteration of foods might in some 
instances affect health by upsetting the planned balance of 
a diet. A cereal used to adulterate sausage is itself a health¬ 
ful food, but it does not have the food properties of meat. 
Such adulteration is obviously so well tolerated a hazard 
as not to harm the average person at all. The adulteration 
of foods marketed for the use of babies or invalids is more 
menacing; a weakened digestion which can tolerate arrow- 
root flour better than the cheaper corn flour, might be 
adversely affected by a substitution of corn flour for the 
other. 

The practice of mixing cheap foods with expensive is 
objectionable only if there is deception about it. The 
marketing of canned preparations of skimmed milk and cocoa- 
nut oil is no menace to health, and it yields a wholesome, 
palatable, and cheap food. Imitation butters, which consist 
partly or wholly of fats cheaper than that of milk, have as 
great food value as butter; only the taste is inferior. Persons 
in straitened circumstances might be able to afford a greater 
quantity of these substitutes than of the higher priced 
articles and so to get a greater health value from them. 

Summer Diet.—A diet containing too much nourishing 
food leads to overweight, and in summer to an excessive 
heating of the body. A summer diet too full in protein and 
other fuel foods may overheat the body and increase sweat¬ 
ing and other discomfort. Metabolism is slower and requires 
less fuel in warm than in cold weather. An unabsorbed sur¬ 
plus of food is to some extent decomposed in the bowel, with 
production of heat. The too nutritious diet leads also to 
increased weight, which is most undesirable in the hot 
weather. The best summer diet contains much vegetable 
and fruit, and relatively little of the highly nourishing foods. 


FOODS AND NUTRITION 


143 


A diet of this type tends to counteract overheating and to 
reduce weight. 

Obesity.—Overweight results very largely from an allot¬ 
ment through inheritance of a great amount of fatty tissue, 
but a definite reduction can always be effected. Excessive 
overweight taxes the circulation during middle or old age, 
and appears to lessen the chance of long life. For men, 
dressed, a roughly average weight in pounds is 115, plus 
four times the number of inches in height above 5 feet, plus 
7 if over twenty-five years of age, and plus another 7 if over 
forty; women average several pounds less. 

Weight is reduced by cutting down the amount of fat which 
goes into the fatty tissue, and by converting into energy 
the fat already there. The fuel consumed by frequent and 
strenuous exercise must come from the body’s store of fat, 
if the diet is low in fuel food. 

Anti-fat Diet— The diet for obesity should have both the 
fat foods and the carbohydrates limited. Excess carbohy¬ 
drates would not only supply energy and spare the body’s 
fat, but would themselves be converted in part and added 
to the fatty store. Rather than simply omitting such foods, 
it is better to substitute others which afford comparatively 
little nourishment. The anti-constipation type of diet may 
be approximated, except that starchy and fatty foods are 
more restricted, and protein foods perhaps less so. Besides 
plenty of fruits and coarse vegetables, a moderate allowance 
is permissible of eggs, lean meat, and skimmed milk or butter¬ 
milk. Bread and butter are to be taken only in very limited 
amount, and potatoes not at all. Cream, sugars, and sugary 
desserts are to be entirely excluded from the diet. 

Underweight.—Underweight or malnutrition is given a 
precisely opposite type of management. Such strenuous 
exercise as would use up the tissue fats is to be avoided, and 
a diet rich in fuel foods encouraged. Milk and cream mixture, 
taken regularly at meals and at bedtime, is an ideal drink 
for increasing the weight; milk fats are tolerated in consider¬ 
able quantity as a rule without digestive upset. Cream, and 
similarly butter, supplies the tissues with needed fat. 

The general diet should be liberal. Cooked cereals with 


144 


THE FOUNDATION OF HEALTH 


plenty of cream and sugar, potatoes, rice, peas, eggs, and 
other foods of high nutritious value are given preference 
over others. A regularly good appetite is encouraged by the 
avoidance of too frequent eating and of monotony in the 
diet. One objection to malnutrition is that it reduces the 
resistance to tuberculosis; this applies most strongly to those 
in the early period of life. 

Deficiency Disease.—Some dietetic faults quite apart from 
the supply of tissue building material and body fuel have to 
do with the content of so-called vitamins in the diet. These 
elements are widely distributed, and are contained in the raw 
foods used for almost any diet, but they are diminished by 
preserving processes and to some extent by cooking. Absence 
of all raw or fresh foods from the diet has led often to nutri¬ 
tional disturbances termed deficiency disease. 

Sailors formerly sometimes developed scurvy after living 
throughout a long cruise on dried and otherwise preserved 
foods. Scurvy is a disease characterized by pallor, weakness, 
sponginess and bleeding of the gums, and pains in the joints. 
Babies may develop scurvy due to the milk of their feeding 
being boiled, pasteurized or preserved. An allowance of 
orange juice provides them with the needed vitamins and 
is a preventive. 

Pellagra, a digestive disease accompanied by reddening 
and harshness of parts of the skin, has also been thought 
by many to result from a lack of vitamins in the diet. A 
similar deficiency has been held partly accountable for the 
development of rickets, a disease of infancy in which parts of 
the skeletal system become inflamed. 

Vitamins.—Different vitamins combat different disorders. 
There are probably many of them, and three have been 
clearly defined; of these three, the solubility in fat or water, 
the stability under action of heat and chemicals, and the 
nutritional properties vary distinctly. One of these combats 
a form of ophthalmia and possibly rickets, another beri-beri 
—a disease prevalent in the Orient—and the third scurvy. 
The study is too incomplete for clear definition, as regards 
either composition or mode of action of the vitamins; the 
present evidence shows little except that certain diseases, or 


FOODS AND NUTRITION 


145 


other less clearly defined conditions of malnutrition, might 
develop if the respective vitamins were not present in the 
food eaten. 

Some foods have a greater natural content of vitamins 
than others. Tomatoes, composed almost entirely of water 
and plant fiber and with a minimal value for tissue building 
or fuel, are yet quite valuable due to the high content of 
vitamins. Tomatoes retain much of this content even after 
canning. Beans and peas are rich in vitamins, as are many 
other cooked foods. The need of foods exceptionally rich 
in vitamins, or of some raw foods, should be kept in mind 
by individuals who are forced to subsist on an unnatural kind 
of diet. All such diets as most people relish are pretty sure 
to have sufficient. There is no reason to think that people 
on an ordinary, appetizing diet could attain additional 
health or vigor by supposed vitamin medication, in the form 
of yeast-eating or otherwise. A natural, fresh diet cannot be 
improved on in respect to vitamin supply. 

Mineral Salts.—Various mineral salts are required by the 
tissues. Table salt is added to nearly all diets, as raw food 
matters have less sodium chloride^ than the tissues need. 
More of this than of any other inorganic salt is necessary in 
the body fluids. There is also a heavy demand for salts of 
lime, a principal constituent of bones and teeth. Pregnancy 
and some inflammatory disorders draw heavily on the body’s 
stock of calcium, and the latter is supplied by a disintegra¬ 
tion of bones and teeth unless provided in large amount 
by the diet. Foods rich in calcium are milk, cheese, yolk of 
egg, spinach, peas, beans and many fruits. 

Iron salts are concerned in the formation of red blood cells 
and other tissues. The pallor brought on by many diseases 
indicates a falling short of the body’s supply of iron. A 
pallor, or anemia, is combated by eating foods rich in iron, 
and sometimes by taking iron salts themselves. Iron is 
plentiful in almost any common diet; among the foods which 
have a considerable content of it are yolk of egg, spinach, 
most other greens, molasses, prunes, raisins, whole wheat, 
oats, peas, and beans. 


10 


146 


THE FOUNDATION OF HEALTH 


Flavors and Extractives.—Flavoring substances and extrac¬ 
tives, though not in themselves nourishing, stimulate the 
appetite and in moderation add much to the normal diet. 
Clear meat broth is a solution of extractives and supplies 
little to the tissues besides water, but it finds a place on many 
tables. These substances and the condiments stimulate the 
flow of digestive juice and probably have additional minor 
influence. 

Clinical observations suggest that an excess of the extrac¬ 
tives tends to raise blood-pressure and to irritate the kidneys. 
It is supposed to hasten the process of arterial hardening and 
of interstitial nephritis, or sclerosis of the kidneys. Spices 
and condiments, or an excess of protein, are sometimes 
thought to have a similar effect. Specific knowledge of this 
is scant, but it can be said generally that the habituation 
to an excessively rich, highly spiced, and highly flavored 
diet, especially after middle life, is often associated with this 
class of disorders. 

Taste.—The body makes one more demand of the diet 
which is rather less subject to specific definition than the 
foregoing. The diet is to attract the appetite. The taste 
offers some inexplainable yet tangible indication of nutri¬ 
tional demands. Many substances must be supplied to the 
tissues and their proportion varies in different foods. Some 
of the fuel must be fat; proteins must embrace certain amino- 
acids. A monotonous diet or one which does not attract 
the appetite is likely to be rather short on some food element 
for which the tissues are calling. However wholesome a 
meal may appear on paper, it is unsatisfactory for those 
with delicate nutritional tolerance unless it is also appetizing. 
In tuberculosis, for instance, the nutrition can be maintained 
only by a good, full diet, and non-appetizing or too monoto¬ 
nous meals can be eaten only sparingly. 

The taste is not to be given too much preference over the 
other requirements, because taste discriminates most unrea¬ 
sonably in favor of sugars. This may possibly be because 
sugars are disposed of more easily than other foods, and with 
less work by the digestive tract. Inactive people who yield 
too greatly to their taste are likely to eat too much candy 


FOODS AND NUTRITION 


147 


and sweets, and as this meets their energy requirement 
they neglect the foods with vegetable fiber and protein. 
The development of pallor, indisposition, constipation or 
overweight eventually results. 

Infant Feeding.—Babies frequently suffer from a diet too 
rich in sugar; the latter goes into fat, and as parents desire a 
fat baby the sugary feedings become popular. This diet 
makes them fat and pale in appearance, and lowers their 
resistance to diarrheal diseases and various infections. The 
formulae on infant feeding packages too often suggest a 
feeding overrich in sugars, the sugar being part of the pack¬ 
age’s content. Use of the sweetened condensed milk sold 
for babies feeds excess sugars to them. 

Feedings with cow’s milk as a basis should be so estimated 
as to give proper fuel and protein values. Some sugar must 
be added because cow’s milk has less sugar naturally than 
the baby’s ideal food, which is breast milk. Babies do well 
on ordinary cane sugar as a rule, but there are exceptions. 
The sugar best tolerated by the infant’s digestive system is 
dextri-maltose; strangely enough, this is less disturbing 
than milk sugar. In making up the formulae, the proportions 
of milk, sugar, and water are gauged according to the age 
and weight of the baby. 

Caloric Formulae.—The baby requires a higher caloric 
allowance per pound weight than does the older person, on 
account of its very rapid growth. Instead of the 20 calories 
per pound weight, allowed adults, the baby is given 40 or 45. 
It is given about 15 per cent, or 6 calories, of this in protein 
instead of the 10 per cent provided for in diets for adults. 
Cow’s milk contains protein enough to yield about 4 calories 
per ounce, so the proper protein allowance per pound weight 
daily is in 1| ounces of milk. This pound weight allow¬ 
ance of milk gives a total fuel value of about 31 calories, as 
milk yields approximately 21 calories to the ounce. Suffi¬ 
cient sugar is therefore added to bring up the total from 31 
to the 40 or 45 required, or enough to yield about 11 calories. 
A level teaspoonful—about T V of an ounce—of most sugars 
yields something like 11 calories, and this is the desired addi¬ 
tion per pound weight. 


148 


THE FOUNDATION OF HEALTH 


To the day’s feeding, containing 1§ ounces of milk and a 
teaspoonful of sugar to each pound of the baby’s weight, is 
added enough water to make 5 or 6 feedings, each as large 
as the baby can take. There are 6 daily feedings at equal 
interval for the first month or so, after which the number is 
reduced to 5 by lengthening the interval at night from four 
to six hours. After eight or nine months the night feeding 
is put forward to permit eight hours of uninterrupted sleep. 
The total amount of each feeding is worked up to 2J ounces 
by a week or so from birth, after which it increases by 1 
ounce each month for three months, and after that \ ounce 
each month. These quantities contemplate the filling of the 
stomach and the passage of an extra ounce into the intestine 
during the feeding. 

A four-month baby weighing 11 pounds has, for example, 
5 feedings daily, each of 6 ounces, or a total daily amount of 
30 ounces. Of this 16| ounces—weight times 1§—are milk, 
and the 13J ounce remainder water. Of sugar is added 11 
level teaspoons—weight times 1. This computation is easy 
and gives a much better approximation of correct food values 
than do most of the formulae which advertisers bring into the 
hands of mothers. 

Strictly accurate computations, such as would be made by 
the pediatrician, are obtained by summing up total calories 
of the day’s feeding, as was described for the mixed diets of 
older persons. Many of the leading pediatricians continue 
to estimate formulae on a percentage basis, in preference to 
the newer caloric basis. 

Drinking water is given about midway between feedings if 
the baby is awake; babies are awakened for the feeding but 
not for water. The water is boiled, unless known to be free 
from germs. Even greater care is to be taken that the baby’s 
milk is free from germs. Market milk in many localities is 
highly contaminated, and is safe as an infant food only if 
pasteurized or boiled in the home. As the heat tends to 
destroy vitamins, the baby should be given a teaspoonful 
of orange juice between feedings. 

The amount of cow’s milk is increased up to but not beyond 
1 quart daily; beyond this point the food values are increased 


FOODS AND NUTRITION 


149 


by solid foods. At any time during the last half of the first 
year, cereals may be added; in the last month or so they are 
needed, in order to fill out the measure of fuel food. Some 
pediatricians advise the addition of some other vegetable 
foods as well, late in the first year. Meat is deferred until 
later babyhood, when stomach acidity for the activation of 
pepsin develops. 

The diet during the second year is gradually broadened 
to include toast, soups, well cooked vegetables, and fruits. 
During the third it increases to a fairly general diet of three 
meals a day, but exclusive of the less digestible articles such 
as pork, fried foods, highly spiced foods, and pastries. The 
pound weight allowance is continued at 40 calories for three 
or four years, after which it is decreased each year by about 
1 calorie. Tendencies to constipation are combated by 
fruits and vegetables as before outlined for the adult. 

Dietetic Errors.—The dietetic measures outlined in this 
chapter are those which prove most compatible with normal 
nutritional functioning. The average human machine can 
tolerate much variation from this, and is likely to get along 
well in spite of abuses. Many people on queer diets retain 
such manifestly good health that no change is even to be 
recommended. It is the baby, or the person who is under¬ 
weight, or the one troubled in some way with his digestion, 
who needs to have the diet most carefully regulated. 

Reading.* 

General , Lee, Chapter II. 

Physiology and Hygiene of Nvtrition, Hough and Sedgwick, 
Chapters XIII and XIX. 

Classes of Foods, Dietaries, etc., Woodman and Norton, 
Chapter VII. 

Food Values, Sherman, Chapter XIV. 

Overweight and Underweight, Fisher and Fisk, Supplemen¬ 
tary Notes, Section II. 

Vitamins, Mathews, Chapter XX. 

Nutritional Disease, Winslow, Chapter XVI. 

Infant-feeding Formulae, Grulee, Chapter XI. 

* See bibliography for titles and publishers of books. 


CHAPTER IX. 


SENSATION AND MOTOR CONTROL OF THE BODY. 

Nervous System.— The brain and spinal cord connect with 
and control the activity of other organs, by means of nerves. 
The cells of the nervous system have irregularly shaped 
bodies which extend out into long fibers; the fibers are highly 
conductive for impulses of various kinds. Many fibers 
(< dendrites ) gather and conduct impulses into a cell body, and 
one of a different sort (axon) carries the impulse out. The 
exact nature of nervous impulse is unknown. 

Gray matter, which constitutes the outer layer of the brain 
and the inner portion of the spinal cord, consists very largely 
of the nerve cell bodies. The white matter, which forms the 
brain’s interior, the cord’s exterior, and the nerves, is mainly 
a mass of the fibers. 

Types of Impulse.— The nerves themselves are long bundles 
of the fibers; their function is to transmit impulses, which are 
of two types. Fibers of sensory nerve cells bring to the brain 
or cord such impressions as to show what activity is desirable 
for an organ. These fibers terminate in end-organs peculiarly 
adapted for the picking up of impulses. Fibers of motor cells 
take back from the brain or cord to the organ some impulses 
to cause the desired activity. It is only through motor 
impulse that any muscle contracts, and that some of the 
glands secrete. This regulates the activity of the body to 
accord with the demands. The nervous mechanism harmon¬ 
izes the functions of the body. 

Reflex.— A nerve cell cannot function independently. An 
impulse needs at least two cells, one to gather up the impulse 
and another to send it on as an activating force. The func¬ 
tional unit of the nervous system may be regarded as the 
combination of a sensory and a motor cell (simple reflex arc). 


SENSATION AND MOTOR CONTROL OF THE BODY 151 


The simplest of the nervous activities are those of a purely 
reflex type. One does not become conscious of accidentally 
touching the lighted end of a cigar, but he becomes conscious 
of just having touched it; he jerks away by the reflex nerve 
action before the realization of pain comes. 



Fig. 17.—Reflex arc. 


The reflex of two cells does not play any large part in the 
human nervous system. Man’s reflexes are more complex, in 
that a series of more than two cells is concerned in any 
activity. The impulse passes over a complicated chain of 
cells before its final transmission to a muscle. Furthermore, 
each reflex functions in correlation with others, rather than 
by itself. Many sensory impulses influence one motor action. 

Senses.—Senses are conscious reactions to certain sensory 
impulses. They may arise either from naturally recurring 
impulses or from impulses which occur because of abnormal 
conditions. We speak of a sense of sight, and a sense of pain. 
This sensory apparatus, for the most part, develops and 
functions normally without the need of hygienic effort. In 
some instances its development is not independent of such 
effort. Intensive training of sensory tracts in the brain 
heightens a capacity for sensing—the increased auditory 
power of blind persons, and the gustatory power of trained 
tea tasters, are examples. 

The functioning of a few of the senses can be improved 
through hygienic aids, to be directed in some cases to the 
sensory nerve elements themselves and in others to accessory 
tissues. Senses may need protection from too powerful 
stimulation. Attention must more frequently be paid to the 




152 


THE FOUNDATION OF HEALTH 


condition of the organs which bring vibrations to the nerve 
endings. Most cases of deafness or blindness would be pre¬ 
ventable through care, not of the nervous tracts, but of the 
accessory organs. 

Hearing.—Life in a noisy place might aggravate a neurotic 
tendency, for the reacting nerve elements tire if a sound of 
monotonous pitch is too much prolonged. Entirely normal 
persons also suffer from excessive noise, though not so much. 
The disposition is often upset thereby and productive thought 
made impossible. Sleep too is interfered with. Frequent 
disturbance to slumber, due to the room not being kept 
quiet, leaves a distinct mark on the mental health of babies 
and children. 

A much greater health consideration of hearing has to 
do with ailments of outer or middle ear. These organs 
transmit sound waves to the end-organs of hearing in the 
internal ear. The three sections of the ear are walled off 
from each other by membranes, which prevent most of the 
disorders of one from affecting also the others. 

External Ear.—The external ear serves only as a canal 
from the outside. It terminates with the drum membrane, 
separating it from the middle ear. It is lined with skin, in 
part of which are hairs and hair follicles. The common dis¬ 
orders are infections about the hairs and a plugging up of the 
canal. The former is suggested by tenderness of the ear to 
manipulation, without difficulty in hearing. The latter is 
suggested by a stuffed up sensation, with some impairment 
in hearing and without pronounced ache or pain. 

An excessive accumulation of the waxy secretion which 
forms in the external ear may entirely close the canal. Appar¬ 
ent persistence of water in the ear after swimming may be 
the first suggestion of it, for water swells the wax. Wax can 
usually be washed out with a stream of warm water; some 
prefer water with a little baking soda dissolved in it. The 
ear is held downward and the stream from a bulb syringe 
directed upward into it and allowed to drain back freely. 
Accumulations so hard as to require scraping out should not 
be worked on at home, but only by a physician. 

Foreign bodies should also be removed by a physician, 


SENSATION AND MOTOR CONTROL OF THE BODY 153 


unless they can be shaken or dropped out; unskillful poking 
about in the ear is likely to drive them farther in. The 
foreign body may be an insect which would itself crawl deep 
in; insects cause an excessively irritative sensation, rather 
than the symptoms just noted for lifeless objects. 

Middle Ear.—The middle ear opens through the Eustachian 
tube to the throat. Under certain conditions the tube swells 
shut and by disturbing the air pressure in the middle ear 
causes a sensation of stuffiness and an impairment of hearing. 
One such condition is the common cold; this is of course 
temporary and of little significance. More permanent types 
of impairment result from the extension of inflammatory 
conditions through the tube to the middle ear. A catarrhal 
inflammation there, involving different structures in such 
wise as to impede their functioning, is not uncommonly 
associated with adenoids or chronic inflammation of the 
throat. 

The more acute type of middle ear disease, by an extension 
of pus infection through the tube, has been mentioned. 
Many cases of defective hearing originate with such infec¬ 
tions, frequently that which complicates scarlet fever. The 
different affections of the middle ear have left a few of every 
hundred persons with some hardness of hearing in both ears, 
and a much greater proportion in one. 

Acute infection of the middle ear reveals itself by fever, 
earache, difficulty in hearing, and sometimes running ear. 
With running of the ear the danger diminishes. If the drum 
membrane remains intact and prevents drainage through it, 
the pus is more likely to force its way into the mastoid cells 
behind. The resulting infection there, mastoiditis, requires 
extensive surgical work, or may lead to fatal complications. 
Middle-ear disease should be treated at once by a specialist, 
who will if necessary lance the drum; this operation does not 
affect the hearing, as the opening rapidly heals when the pus 
formation subsides. 

Vision.—Disorders of vision are likewise of the accessory 
apparatus rather than of the nervous mechanism of sight. 
The eye is a camera whose box, or sclera, is nearly spherical 
and consists of dense, tough fibrous tissue; it has a circular 


154 


THE FOUNDATION OF HEALTH 


transparent outer lens ( cornea ) in front. The sensitive screen 
on which the view is reproduced is called the retina ; the 
latter together with the choroid membrane lines the sclera, 
except in front. The visual purple in the retina, a substance 
analogous to the chemical coating on the camera film, is 
bleached temporarily by the light rays. This reaction of 
the light, together with others, stimulates certain cells ( rods 
and cones ) at the reacting points in the retina, each of which 
connects with an optic nerve fiber passing to the brain. In 
this way the entire picture sends its impression to the brain 
for perception. 

Accommodation.— Projection of an image on the retina 
requires a focussed lens. A view is reproduced in the eye 
only if the light rays from any given point in the view can be 
focussed to a corresponding point on the retina. A stronger 
lens is required to focus rays from a near-by than from a 
distant object, for the distance from lens to retina is fixed. 
A muscle of accommodation varies the strength of an inter¬ 
nal lens to provide for this. The lens is firm but yielding, 
and is elastic. It hangs by ligaments from structures at the 
anterior margin of the choroid membrane, situated between 
sclera and retina. 

Eye-strain.— Eye-strain is a term applied to the weakness 
(asthenopia) which results from an overtaxing of muscles 
concerned in vision. It is spoken of as accommodative when 
it involves chiefly the muscle of accommodation within the 
eyeball, which regulates the curvature of the inner lens. This 
is a ring of muscle ( ciliary muscle ) attached to the inner sur¬ 
face of the sclera, around the outer lens. From this front 
attachment, the fibers radiate backward into the eyeball 
and so attach posteriorly that by contracting they pull 
forward the choroid membrane which supports the inner 
lens. This loosens the attachments of the lens, and allows 
the latter to swell by its own elasticity, to become more con¬ 
vex, and to focus nearer objects on the retina. It is there¬ 
fore near vision which taxes the muscle; contraction is for 
near-by and relaxation for distant focus. 

Strain is sometimes termed neurasthenic when it is part 
of the weakness of a neurasthenic complex; this complex 


SENSATION AND MOTOR CONTROL OF THE BODY 155 


will be discussed later. The strain is spoken of as muscular 
when it involves the muscles in control of the direction of 
gaze. 

Squint.— Muscles in the socket, outside the eyeball, are 
so attached that their contraction rolls or turns the eyeball. 
The strongest are those on the medial side of the two eyes, 
which turn the eyes inward to permit vision by both of one 
object. Near vision adds to the contraction demanded of 
these medial muscles, and an overtaxing of them is a common 
form of muscular strain. 

Squint (. strabismus ) is due to some fault of the external 
muscles of the eye; it may assume different forms. Common¬ 
est among these is the convergent squint, or crossing of the 
eyes. Double vision is avoided by an unconscious suppres¬ 
sion of sight in one of the eyes, with eventual blindness in it. 
Sight can sometimes be preserved to both by the alternate 
covering of first one and then the other eye until operation 
is feasible; the place of attachment of a muscle is then 
changed surgically and the direction of gaze thus brought 
to normal. The milder defects of these muscles can often 
be overcome by corrective exercises. Cases should go as 
early as possible into medical hands. 

Symptoms of Strain.— Headache is a symptom suggestive 
of eye-strain. There occurs also a sense of fatigue about the 
eyes, and sometimes an itching of the lids or muscular 
twitchings. Occasionally there is dizziness, double vision, 
or nausea. The close worker might as well stop when such 
symptoms assail him, for with eyes in this condition the prog¬ 
ress would be too slow to compensate for the injury done. 
Rest for the muscles is by their relaxation with distant views, 
or by lying down and closing the eyes. The tendency of 
school children to gaze off into space is in part an unconscious 
attempt to rest the eyes. 

Causes of Strain.— Prevention of strain is by avoidance or 
correction of the various causative factors. Strains result 
most largely from defects in the curvatures of the lenses or of 
the eyeball. They may also result from excessive near vision, 
poor definition of the objects studied, or shifting or bad 
position of the object. Poor definition of an object, often 


156 


THE FOUNDATION OF HEALTH 


due to small size of the print being read or to reflected 
lights from highly glazed paper, exacts such close focus to 
get a maximum impression on the retina that the muscles 
suffer. The bad relative position of an object sometimes 
strains the eyes of one reading in bed, or the shifting about 
of the object strains those of the person who reads in the 
train. Such abuses as these tire the eye quickly, and are 
likely to overtax and strain one with inherent imperfections. 

Refractive Error.—The refractive defect which interferes 
with sight at close range, generally called far-sightedness 
(hyperopia), is such a misshapening of the eyeball as to bring 
near objects to a focus behind the retina, unless the muscles 
of accommodation contract excessively to shorten the focus. 
Another defect is of the curvatures of either cornea or inner 
lens, the segment of an ovoid rather than a spherical surface 
being assumed. The refraction of one meridian of such an 
eye differs from that of another; the eye focussed on one line 
does not focus on another line at right angles to it ( astigma¬ 
tism) . Clear vision in this case requires an irregular accom¬ 
modative contraction, and this may strain the muscles. 
These and other refractive errors are the commonest cause 
for strain of the eye muscles; they are corrected by supple¬ 
mentary lenses, in the form of glasses. 

Such defects, even though hereditary and present from 
birth, do not often become evident until the child reaches 
school age, with its added requirement for close work. One 
or two school children in every ten need glasses, and without 
them their eyes and their studies suffer. The eyes of a child 
who, at a distance of 20 feet in a good light, cannot recognize 
with each eye separately a very heavily drawn design i 
of an inch high, should be examined by an oculist. The 
occurrence of headache, aversion to reading and reddening 
about the eyes should not be waited for, before having the 
eyes examined. Only the physician who has made special 
study of the eye can be relied on for the fitting of glasses; 
many incompetent persons pretend to be qualified to do this 
work. 

Visual Aging.—Too much near work by the very young is 
said to alter permanently the yielding tissues of the eye. 


SENSATION AND MOTOR CONTROL OF THE BODY 157 


Near-sightedness (myopia) has been attributed in some cases 
to very early school work. Close work should not be done in 
kindergarten. The reading of ordinary book print should 
be deferred until the seventh year or later, and any reading 
before this done from large charts. 

As age increases, the tissues become more and more firm. 
The lens gradually hardens, until at about forty-five years 
of age it has largely lost its elasticity. It does not then 
respond to the loosening of its attachments in accommoda¬ 
tion, and near vision requires the use of reading glasses. It 
continues its hardening, and as it hardens contracts and 
increases its curvature. When old age is reached the lens 
in many instances no longer focusses for distance but does 
for reading, even without accommodation; this is the phe¬ 
nomenon of “second sight.” 

Excessive Glare.—The choroid membrane contains the 
supply of vessels for the nourishment of the retina and lens. 
Being heavily pigmented and opaque, it also serves to keep 
the interior of the eyeball dark; no light enters except that 
through the pupil. Anterior to the choroid is the iris, which 
has similar pigmentation. The pigment in some persons, 
particularly blonds, is insufficient to protect the retina from 
the glare of tropical and subtropical regions, or from that of 
white expanses of snow. The eye is strained by the spasmodic 
attempt of the iris to reduce the pupil and shut out the light. 
In addition there are irritative effects from the excessive 
ultra-violet ray in such strong light. Sun glasses afford the 
logical protection from glare; they are required only by those 
in whom the light causes discomfort or other symptoms. 

Pain.—Senses for the perception of bodily disorder are often 
so unpleasant as to be carelessly regarded as diseases; instead 
they are symptoms of disease. The management is primarily 
of the disordered tissue from which the nerve arises; as in the 
case of defective vision and hearing it is not of the sensation 
itself. An ache or pain is to be relieved, of course, if it can 
be done harmlessly, but this is secondary to the treatment of 
the causative disorder. 

The pain from a wound is made worse by the stirring up 
of crushed tissue, and the first aid given should guard against 


158 


THE FOUNDATION OF HEALTH 


such excitation. An eyelid with a cinder under it is eased if 
held shut by the pressure of a pad until the cinder can be 
removed. Digging of the broken ends of a fractured bone 
into surrounding tissue may pain to the point of shock. 
The patient should not be lifted about until a board, stick 
or other temporary splint can be bound alongside the injured 
member. In addition to supporting the part for rest, the 
application of heat, or sometimes of cold, offers relief. Hot- 
water bags, or cloths wrung from hot water, are put over 
the pained organ. Cold application serves the same purpose, 
but is usually less effective. 

Analgesics.—Liniments, medicated plasters, and drugs 
taken by mouth, while of value in some cases are useless or 
even harmful in others; none are recommended for indis¬ 
criminate use. Continual crying by the baby is a matter 
for the physician, not for paregoric or soothing syrups; these 
depend for their effect on opiates or other undesirable drugs. 
Aspirin ( acetyl-salicylic acid) frequently relieves aches and 
is less injurious than most other drugs taken for the purpose. 
Small doses do no harm to one whose heart and circulation 
are normal; mild gastric symptoms occasionally follow. The 
dose is 3 to 5 grains, taken once every few hours until the ache 
subsides. Those who accustom themselves to the drug get 
no effect except by much larger doses. 

Narcotics.—The smallest doses of habit-forming drugs, such 
as the derivatives of opium or coca, are harmful in that they 
create a craving for more. Somebody has suggested that 
the tissues must form in excess a resistive substance to the 
drug, and that this substance happens to have a peculiarly 
irritant effect on the body until neutralized by more drug. 
The craving increases rapidly, and subsides only very slowly 
when the drug is later abstained from. Drug users are with¬ 
held from cure also by loss of mental efficiency and will 
power; the drugs gradually destroy mental faculties of the 
habitues. Only exceptionally can cases do brilliant think¬ 
ing while under narcotic influence, though much fiction 
has been based on the supposition of such brilliance; the 
exceptional few have corresponding periods of depression 
afterward. 


SENSATION AND MOTOR CONTROL OF THE BODY 159 


The drug habit is not infrequently acquired through the 
use of morphine being continued for weeks to control pain. 
Lovers of excitement take it up too, simply as a new thrill; 
for them, it starts perhaps with a wild party, just as other 
forms of dissipation might. A feeling of exhilaration is 
produced at first, which helps the habit to become established. 
Later this feeling is wanting, but by then there is the craving. 
Gradually there appear nervous twitchings, restlessness, con¬ 
stipation, loss of weight and other symptoms. Marked symp¬ 
toms are in some cases noticeable after a period of months, 
and in others only after many years. Some are affected much 
less than others, as individual resistance varies. 

Headache.—The aching discomforts which are most com¬ 
monly treated at home are those of head and of back. Head¬ 
ache occurs as a symptom of many disorders, the recognition 
of which is the first essential to treatment. The logical 
remedy for one headache would do harm in other cases. 
Causes of headache are sometimes classified as toxic sub¬ 
stances in the system, general circulatory disorders, inflam¬ 
mation about the head, pressure within the skull, inherent 
nervous qualities, and reflex. 

Toxic headaches are those due to fevers, drugs and possibly 
constipation. The toxins due to febrile disease are less 
easily avoided than those which come from an excessive use 
of tobacco or coffee, or from overeating; in all, an avoidance is 
the key to control. Rest in bed and cold application to the 
head often gives some relief. The headache associated with 
constipation has long been attributed to toxic substances, 
though some recent evidence throws doubt on this; treat¬ 
ment is of the underlying constipation, as outlined pre¬ 
viously. 

Headache Powders.— Headache powders, or even aspirin, 
give temporary relief, but they do not tend to cure and they 
may aggravate the headaches due to the second group of 
causative factors. Such circulatory conditions as high blood- 
pressure, anemia, or heart defects may be adversely affected 
by any of these preparations, unless given carefully under 
the supervision of a physician. Many of the proprietary 
headache medicines are harmful in themselves, regardless 


160 


THE FOUNDATION OF HEALTH 


of the patient’s circulatory condition; those of an unstated 
composition are in no case to be trusted. 

The surgeons in charge of local inflammations about the 
eyes, sinuses, ears or teeth, usually allow aspirin or other 
similar drugs for the control of the aching; it is inadvisable 
to take a dose before consulting the surgeon, as the symptoms 
might be masked and the diagnosis interfered with. In 
these cases and in those of brain tumor or other intracranial 
conditions which cause headache, a physician would be in 
charge anyway and home remedies not thought of. 

Sick Headache. -Eye-strain and pains along the nerves 
(' neuralgia ) often cause headache reflexly. Many of the 
headaches at first ascribed to constipation, biliousness, or 
overtiring, are relieved by the wearing of properly fitted 
glasses. The attacks popularly referred to as sick headache 
or “migraine” might fall in the same class; they are not of 
uniform causation. Each individual case needs medical 
study. 

The true migraine headache is due to an inherited trait. 
This occurs most frequently in women; it tends to be worst in 
the first half of life and toward middle life to subside. Little 
can be done for it, except the control of attacks as they come. 
Medication with aspirin, in conjunction perhaps with allied 
chemicals, may abort the attack if begun at the earliest sign 
of its approach. Visional disturbances often precede the 
headache itself, and the treatment should begin with these 
first symptoms. 

Backache.—Backache occurs as a result of toxic action, 
especially in infectious disease, of skeletal disorders about the 
back and pelvis, of disorder about the viscera, or of local 
affection of muscles or nerves in the back. Until the deter¬ 
mination and correction of the cause is possible, relief is best 
afforded by rest in bed and sometimes by application of heat. 

The toxic backache accompanies a corresponding toxic 
headache, and is managed similarly. Causative skeletal 
disorders are sometimes inflammatory, those caused by 
rheumatic arthritis or tuberculosis for instance. Sometimes 
they are strains of the ligaments by bad posture, overexertion 
or mechanical injury. Abdominal or pelvic viscera with 


SENSATION AND MOTOR CONTROL OF THE BODY 1G1 


faulty suspension, resulting in visceroptosis or uterine mal¬ 
positions, may drag on the supports and cause backache. 
Backache is not commonly a result of kidney disease, as some 
advertisers of pills would have us think. 

Dizziness.—A sense of dizziness (vertigo) indicates a dis¬ 
turbance to some part of the mechanism of equilibrium. 
Sea-sickness results from an overtaxing of this mechanism. 
Dizziness results also from physical disorder of the organs 
of equilibrium, of the semi-circular canals near the inner ear, 
an organ of equilibrial sense, or parts of the brain. Arterial 
hardening in old people not infrequently involves the vessels 
of the brain, and dizziness may occur as an early symptom; 
heart defects or anemia similarly cause dizziness. The rapid 
growth of youth is sometimes associated with attacks, due 
to the instability at that time of the vascular tone. This 
condition in young people has little significance, but in 
older people a more serious circulatory disturbance is sug¬ 
gested. 

Body Equilibrium.—Much of the sensory impulse leading 
to motor activity comes through the conscious senses. The 
body’s equilibrium requires just so much activity in each 
of the many muscles. To maintain it, an accurately gauged 
force of impulses must be distributed among the various 
motor nerves. This distribution would vary according to 
whether the individual were standing in a room, in a street 
car, or in a wind storm. The central nervous system is put 
in touch with these outside conditions by sensory nerve 
impulses, on which depends the distribution of the motor 
impulse. 

Sensation of equilibrium, from the semi-circular canals, tells 
of any tilting motion of the floor beneath. Sight has addi¬ 
tional influence, as does hearing and other sensations. There 
are sensations from the muscles, called deep muscular sensa¬ 
tion, which are carried up to the brain through certain tracts 
in the spinal cord; they show the existing state of muscular 
contraction. Tabes, or locomotor ataxia, is a syphilitic infec¬ 
tion of these tracts in the cord; the incoordination character¬ 
istic of the disease is due to the cutting off of these deep 
muscular sensations. All the sensory impulses are transmuted 
11 


102 


THE FOUNDATION OF HEALTH 


into motor impulse, coordinated, and sent to the proper 
muscles to maintain equilibrium. 

Vital Centers.—Other motive functions of the body require 
nervous impulse much more constantly than does the skeletal 
musculature. The heart, for instance, must have a continu¬ 
ous series of impulses. Such impulses come from a group of 
vital centers in the lowermost segment of the brain, which are 
supplied with their sensory stimuli automatically. Centers 
in control of breathing and of heat regulation were alluded 
to in an earlier chapter. 

Another center regulates the contraction and dilation of 
bloodvessels. This one sends its motor stimuli through the 
vasomotor nerves to the muscular coats of the bloodvessel 
walls. Vasomotor impulse may dilate the vessels of the 
viscera and take the blood largely to the abdomen, or it may 
bring the blood to the surface of the body by contracting 
the visceral vessels and dilating those of the skin. 

Consciousness.—Increase of the blood circulation about the 
brain is by the forcing out of blood from the skin and viscera, 
rather than by active dilation of the brain’s own vessels. 
For consciousness the brain requires a rich supply of blood; 
if the supply is reduced drowsiness or even unconsciousness 
results. As other organs can actively draw blood from the 
higher centers of the brain, and not vice versa , conscious 
activity depends in part on the care given these other func¬ 
tions. Mental work is retarded in an excessively heated 
room, because the blood is taken into the skin for elimination 
of heat, and particularly after a heavy meal when the blood 
is also being drawn so greatly to the digestive tract. 

The blood’s unaccustomed call to the surface by the 
weather’s warmth might cause much of the drowsy “spring 
fever” symptoms. This explanation, or anything else we 
know of the causation of the early summer languor, would 
not lead us to expect results from the popular treatment 
with spring teas and spring tonics. The latter are laxative 
and for reasons already set forth are better avoided; the 
former supply the system with nothing of value but water. 
Sweetened “sassafras tea” or infusions from other plants 
might attract children more than water would, but they have 
no other hygienic advantage. 


SENSATION AND MOTOR CONTROL OF THE BODY 1G3 


Fainting.—Several forms of unconsciousness are due to a 
reduction of the blood supply to the brain, among them the 
common fainting spell. Fainting is especially likely to occur 
in those with a constitutional circulatory instability; it is a 
tendency of early life which is later outgrown, and there is 
nothing serious about it. Excessive emotion interferes with 
circulatory regulation and may lead into a faint. Nothing 
need be done for an attack; the person comes out of it any¬ 
way. It is better to leave the patient where he falls than to 
set him up, as the gravitation of blood into the head has its 
advantages. 

Unconsciousness.—A person found unconscious is better 
not dealt with too actively until the cause for the uncon¬ 
sciousness is learned. Accompanying convulsions, particu¬ 
larly if there is laceration of mouth tissues, suggests epileptic 
fits as the cause of unconsciousness. The hysterical convul¬ 
sion is sometimes similar but would never lead to injury of 
tissue. Or an alcoholic odor may give the clue. The possi¬ 
bility of poisoning is to be considered, and containers for 
poisonous chemicals might be looked for. Inspection of the 
eye may show the small, contracted pupil of opium poisoning, 
of which very slow breathing is also suggestive. 

Marks indicating a blow on the head suggest concussion of 
the brain or bleeding within the skull. Hemorrhage causes the 
unconsciousness in both these conditions, that of concussion 
being into the brain tissue from many small bloodvessels, 
and the other type being from larger vessels into the brain 
chamber of the skull. Old age of the patient, and evidence 
of physical or mental exertion shortly preceding, suggests 
hemorrhage from some hardened and broken artery about 
the brain (apoplexy). Unconsciousness results from the 
want of blood supply to the cells, due to the pressure of the 
escaped blood against brain tissue. 

Aid to the unconscious consists in first laying the patient 
flat and loosening the clothing about the neck. If the 
patient’s skin seems cold, or if he is in collapse from accident 
or any other cause, he should be covered well with clothing 
or other materials; chilling is one causative factor of shock. 
Further measures depend on the nature of the ailment. 


164 


THE FOUNDATION OF HEALTH 


The cases for very active treatment are those of poisoning, 
as outlined in a previous chapter, and of heat stroke, men¬ 
tioned below. An epileptic should have something placed 
between his teeth, to protect his tongue from laceration. 
Persons unconscious from other causes are to be watched 
but not disturbed too much. Hemorrhage about the brain 
would be made worse by unnecessary or unskilled lifting 
about of the patient. 

Heat Stroke.—Sunstroke (thermic fever: heat stroke) is due 
to an absorption into the body of greater heat than the 
mechanism of heat regulation can eliminate. The surplus 
accumulates and eventually becomes great enough to par¬ 
alyze the center. Heat elimination then stops and the tem¬ 
perature of the body rapidly rises, the mouth temperature often 
reaching 110° F. or even higher. The heat slowly kills the 
brain cells. The only hope for relief is a withdrawal of the 
surplus heat before the brain tissue suffers irreparably. Ice- 
water baths, if possible, and an ironing of the body surface 
with chunks of ice, are the best aid. 

An attack of sunstroke leaves a permanent defect in the 
nervous control over heat regulation; this lowers the sub¬ 
sequent resistance to heat. Alcoholism does the same. In 
some the resistance of the mechanism is inherently low. 
Those who do not perspire well are the most likely to resist 
heat poorly, and should avoid great exposure to it. 

Heat Exhaustion.—Long exposure to more moderate over¬ 
heating, as by working in a boiler-room, leads to a very 
different picture called heat exhaustion. The body feels cold 
and clammy and its temperature falls as the person goes into 
collapse; the patient may or may not become unconscious. 
This is an exhaustion of the circulatory system, apparently 
overstrained by its part in eliminating so much heat; the 
person whose heart is itself defective or has a defective sup¬ 
ply of nervous driving power is especially liable. The patient 
is to be warmed up to normal body temperature. Long rest 
in a properly ventilated room affords gradual recovery. 

Neuroses.—The nervous mechanism for certain types of 
activity might in some individuals be defective and inher¬ 
ently inadequate to handle the necessary impulses. Writer’s 


SENSATION AND MOTOR CONTROL OF THE BODY 165 


cramp results from abnormally poor nervous control 
0 neurosis ) of the hand muscles; no amount of writing would 
so affect a normal hand. Ordinary work causes the defec¬ 
tively supplied hand to have its attacks now and then. 
Similar cramps sometimes suffered by cigar makers or typists 
indicate unconquerable obstacles, and if too troublesome 
call for a change of occupation. There are many types of 
inherent nervous defect, different parts of the system being 
at fault. 

Stuttering.—A type which occurs widely among children, 
and sometimes is not outgrown, is that which leads to stutter¬ 
ing. The speech falls into one monotonous pitch, and for 
talking at this pitch the muscles are not adequately supplied 
from the central nervous system. Spasm of the muscles 
results, with the characteristic disturbance of articulation. 
While the condition is due largely to the inherent nervous 
make-up, its development can be checked to a degree by 
careful hygiene. 

Building up of the child’s physical condition by the removal 
of any adenoids, fitting of glasses if needed, outdoor exercise, 
deep breathing, etc., come first. Mental hygiene, to be 
outlined in the next chapter, should-have even greater care. 
Excitement or fright, aroused by weird stories or by the 
watching of such exciting performances as sham battles, 
aggravates the tendency. Encouragement to singing, and 
to talking with expression rather than in one monotonous 
tone, would lessen the tendency. Treatment of a pronounced 
case of stuttering is best put in the hands of a physician 
skilled in vocal gymnastics. 

St. Vitus’s Dance.—St. Vitus’s dance, or chorea, is a dis¬ 
ease characterized by jerking and uncontrollable movements 
by certain muscles. That of the ordinary type in children 
(Sydenham’s chorea) results when streptococcus infection 
overexcites a group of motor nerve cells in control of some 
muscular action. This infection of the nerves complicates 
a preceding infection, usually of the tonsils, and is preventable 
and often curable by the removal of any accessible foci of 
infection. Other children who see and imitate a patient’s 
convulsive movements might acquire a habit of similar activ- 


166 


THE FOUNDATION OF HEALTH 


ity, but popular apprehensions lest such a habit develop into 
the disease are unwarranted. A chronic chorea of older people 
( Huntington’s chorea) is one of the hereditary diseases. 

Habit Spasm.—Habit spasms are similar involuntary and 
convulsive contractions of certain muscles, frequently of the 
face, but less wild and jerking. This condition does not 
result from infection, but is largely inherent. It is associated 
often with a general neurotic tendency and is most marked 
during the period of rapid growth. It is outgrown as child¬ 
hood is passed, with the occasional exception of a quick and 
involuntary spasm in an eyelid, or of some other muscle. 
No management is needed beyond that looking to the general 
health. Any physical defects should be corrected and 
attention given to mental hygiene. 

Tetanus.—Tetanus is an ordinarily fatal disease, the most 
evident symptoms of which are convulsive; the early involve¬ 
ment of the muscles of the jaw is characteristic and affords 
the popular synonym, lock-jaw. The convulsions result 
from the action on motor nerve cells of toxins excreted by 
the germ of tetanus ( B . tetani ); the germ invades wounded 
tissues and sends its toxins through the blood stream and 
up the nerves to the central nervous system. This germ is a 
rod-shaped bacterium, with spores that can remain alive for 
long periods in the superficial layers of the soil. It develops 
normally in the intestines of horses. When introduced deep 
into the tissues by a dirty wound, the spore passes into the 
vegetative form, develops there and produces its toxins. 

Rather than depend on the available laboratory methods 
for the determination of tetanus bacillus infection in a 
wound, it is better to play safe and take antitoxin after any 
wound that is deep and dirty. The antitoxin is needed early 
if it is to neutralize the toxins before they reach susceptible 
tissue about the brain. After symptoms have developed, it 
is in most cases too late for effective treatment. The inability 
of this germ to vegetate in the presence of oxygen is one point 
for the dressing of wounds open to the air. Sealing of small 
lacerations with collodion mixtures, or even with court 
plaster, interferes with the escape of any pus formed and 
somewhat increases the possibility of tetanus. 


SENSATION AND MOTOR CONTROL OF THE BODY 167 


Reading.* 

General, Woodworth, Chapters XII and XIII. 

Nervous System and its Hygiene, J. F. Williams, Chapter 

XI. 

Neurones and the Nervous Function, Herrick, Chapters 

II and III. 

Brain Tissue and Consciousness , Mathews, Chapter XIII. 
Unconsciousness and First Aid, Lynch, Chapter VIII. 
Hygiene of the Ear, Reik, Chapter II. 

Hygiene of Vision, Terman, Chapter XIV. 


* See bibliography for titles and publishers of books. 


CHAPTER X. 


THE MENTAL PROCESSES. 

Mental Hygiene.—The nervous system was described as a 
central governor for the various activities of the body. This 
governor is directed into comprehensive relationship with 
the surroundings by its highest or mental centers. With 
a wider understanding of the environment, a better position 
in it is attained. As a perfectly healthy function not only 
is free from demonstrable disease but also attains its ends, 
the mind to be considered thoroughly healthy must maintain 
for the person a proper place in the community. 

Physical as well as educative factors contribute to this 
sort of mental health. Their mode of influence is often some¬ 
what confusing, but can be made clearer by a brief survey 
into the nature of the mind’s workings. The sketchy pres¬ 
entation of the latter here made is not by a psychologist and 
undoubtedly contains errors; the field is not as yet clearly 
revealed even to students of psychology. Any errors would 
probably not be sufficient to vitiate conclusions about mental 
hygiene. 

Mechanism of the Mind.—The apparatus for mental activity 
operates as does the rest of the nervous mechanism. A con¬ 
certed action by the body is through the correlation of a 
number of nervous reflexes. Various sensory impulses of a 
nursing baby, for instance, lead to the motor combination 
of sucking. View of the bottle is not a part of this primary 
correlation of feeding impulses, but a bottle-fed baby learns 
to associate the view of a bottle with feeding. Then the 
mere sight of the bottle may start the baby to sucking some¬ 
thing. Some cells of the higher centers become a pathway 
between two formerly isolated seats of activity; in this case 
impulse in a seat of visional perception passes over to the 
correlation path concerned with sucking. 


THE MENTAL PROCESSES 


169 


Association Paths.—Mental associations, of which the 
above is an example, are by means of nerve fibers in the 
brain which connect up other nervous complexes. The chain 
of nerve cells traversed by an associating impulse, though 
intricately extended through the higher centers of the brain, 
controls, as would short reflexes, the course of bodily action. 
This longer and more involved process excels the shorter 
one in that its issue is guided from more directions. It may 
also lead into an activity which profits the more because it 
first hurts. 

The mental process which delays immediate results for 
protracted deliberation may lead into the better activity, 
but to do so it must avoid inconsequential musing; the 
thought to which varied impressions have given rise is of 
value only as it leads to eventual action. The faculty for 
transmitting thought into actual doing is will power. This 
is less a quality in itself than an indication of completeness 
in any mental process, or of the enthusiasm or determina¬ 
tion which would bring it to completion. All sound mental 
training builds will power. Display of will implies definite 
action based on existent views and desires, and only in pro¬ 
portion with the soundness of the views is it a virtue. 

The supposition that given thoughts or actions always 
use the same series of nerve cells allows any of them a definite 
route of travel through the brain. Fibers for some sorts of 
association group themselves together into demonstrable 
bundles (association tracts), though the path of an association 
can be just as well defined when its course is not so readily 
demonstrable. The forced change of a left-handed person to 
become right-handed drives the impulse into an extra trip 
across the brain, and the mental control over manual activity 
becomes to this extent less direct; observers think that chil¬ 
dren with a strong disposition to left-handedness are better 
off so than if trained out of it. 

Attention.—Direction of the body’s activities, to harmonize 
with an infinitely changeable environment, requires a selec¬ 
tive power to pick out the appropriate pathways through 
the brain. Most of this guidance is done automatically by 
the environment. One combination of sensations would 


170 


THE FOUNDATION OF HEALTH 


guide the impulse into one direction, and another into some 
other. A mass of sensation opens up this channel and closes 
that one. 

In the higher centers of the brain the guiding power rests, 
to a degree, with the consciousness. The attention, or center 
of consciousness, is continuously picking out the sensory 
stimuli for mental impulse, some from the memory and some 
directly from the environment. It determines the direction 
for this mental impulse, and consequently for the body’s 
activity. The intensified selective power of firmly fixed 
attention, which amounts to interest or enthusiasm, affords 
the impetus to establish new mental pathways which the 
environment otherwise would not. Thus by its own effort 
the mind forms such association paths as will raise the per¬ 
son’s value in the community. Interest is a basic factor in 
the mastery of a new problem; whatever be the subject 
matter studied, close attention is a requisite to material 
progress. 

Memory and Habit.—The stability of a mental pathway 
depends on some inherent retentive faculties of the mind. 
Each mental impulse leaves behind its impress; evidence that 
it has passed remains in that today’s thoughts are remem¬ 
bered tomorrow. The impression becomes firmer with suc¬ 
cessive repetitions. Some people require several passages 
of a thought in order to remember it as well as others would 
after a single passage. No amount of effort can enlarge the 
essential capacity for remembering. Ability to remember a 
certain type of subject matter increases by repeated thought 
along just that line, or by its association with passages already 
familiar; memory does not thereby improve for dissociated 
subjects. 

The repetition of a thought or action is easier than was 
the original. The first mental passage not only leaves its 
mnemonic imprint, but it establishes a line of less resistance 
for subsequent ones. This is the basis of habit. Anything 
becomes easier to do and harder to avoid after each repeti¬ 
tion. Every impulse, whether good or bad, leaves in the 
mind its influence. 


THE MENTAL PROCESSES 


171 


Concentration. — The first passage of a mental impulse may 
require marked attention and interest. Succeeding repeti¬ 
tions call for less and less. When a path of least resistance 
has been formed the impulse goes its course unnoticed. A 
continued interest in the subject now selects and relates 
with that mental process some other associations. To 
master a study, we continue to focus on it such interest as 
to bring in more and more phases. This fixing of the atten¬ 
tion into one channel, to the exclusion of unrelated ones, is 
concentration. 

Habitual thought on the subject becomes easier, and 
richer in related associations. This channel in the mind is 
gradually enlarged to involve more brain cells, and a greater 
volume of thought is possible. Eventually one becomes an 
expert, and his mind carries a load of which the beginner was 
incapable. Concentration is the greatest voluntary factor 
in study. Interruptions, physical discomforts, or any other 
distractions which would transfer the thoughts, interfere. 

Mental Deficiency.—Deficient minds are those which are 
hopelessly impeded, so far as some essential kinds of associa¬ 
tion are concerned. An apparently stupid child is much more 
commonly the victim of defective sight or other physical 
handicap, but in some an expert’s examination would show 
the defect to be in the higher centers of the mind. The 
mental defectives have long been classified into the idiots, 
whose mentality is advanced only to the stage averaged by a 
baby and who therefore cannot even manage their immediate 
bodily needs, the imbeciles, whose development of mind pro¬ 
ceeds to the young child’s average, and the morons, who 
develop no farther than the twelve-year average. Recent 
workers list also the slightly subnormals, whose capacity sur¬ 
passes somewhat that of the moron. 

Even the least deficient of these are unable to adjust 
themselves well to the rest of the world, and have but feeble 
comprehension of community ideals. The community 
expects that each individual’s pursuits, while benefiting 
himself most directly, shall be of service to the others as 
well. People without a healthy mental equipment cannot 
quite grasp this, and sink toward the narrower and more self- 


172 


THE FOUNDATION OF HEALTH 


centered standard of the underworld, that social order which 
is supported by crime, vice and pauperism. 

Training of Defectives.— The usual denizens of the under¬ 
world are the uncared for mental defectives, and some with 
a mental capacity inherently better but not developed. 
They become social parasites, and derive from the com¬ 
munity a support for which they give nothing in return. 
The drift to the underworld is abetted by poverty and other 
social handicaps. 

Intelligent management of these people must discriminate 
according to the extent to which their condition results from 
inherent deficiency. While some can be reclaimed by change 
of environment and mental discipline, there are others who 
cannot be expected to lead responsible lives and whose exist¬ 
ence needs supervision. Half-witted paupers or prostitutes 
are not capable of a choice between the unsanitary estab¬ 
lishments in which they live and any other. It is the province 
of the mentally competent of the community to see that they 
are transferred to a more hygienic mode of life. 

The training of defective minds is limited to those associa¬ 
tion paths which are normal and capable of development. 
Instances are commonly cited of persons who are totally 
unable to take care of themselves, but who under supervision 
become musicians of considerable worth. The child with a 
defect in its mental make-up gains much more from classes 
specially adapted to its needs than from the grades. Minds 
unsuited for academic training sometimes progress well in 
some sort of vocational work. It will some day be practicable 
to pick out all the defectives during their school age, and by 
properly supervising them to reduce greatly crime and pau¬ 
perism. 

Impediments in the Normal Mind.— Minds not crippled by a 
total incapacity in any direction are nevertheless better 
equipped for some things than for others. Some families 
produce many scientists, while other equally intellectual 
families produce none. The extraordinary interest and 
capacity of a precocious child for one sort of work tends 
sometimes to divert the child to a hurtful degree from other 
mental and physical activity; the special talent should be 


THE MENTAL PROCESSES 


173 


moderately encouraged though not given exclusive rights 
over the mind. 

Broadening of any association path can proceed only 
according to the inherited capacity of that path. The amount 
of interest spontaneously attracted by a type of association 
indicates such capacity; on this depends the adaptation to 
occupations of natural preference. Psychological tests also 
indicate the developmental capacities along a given line, 
and when more fully developed will make ideal entrance 
examinations for professional schools. The inherent struc¬ 
ture of any mind is such that impulses through some of its 
channels run freely, while those through others are naturally 
depressed. 

Psychoses.— Influences other than hereditary make-up 
can also in one way or another depress or animate mental 
activity, some only transiently and others more essentially. 
The most pronounced and serious of these are the various 
psychoses. Psychoses are definite diseases of the mind; an 
attack by any of several agents gives rise to them. To 
a degree they correspond with the insanities, but the two 
terms are not interchangeable. Insanity is a legal term indi¬ 
cating that the relationship with the rest of the community 
is not a sane one, within the meaning of the law. Psychosis 
is a medical term for specific disease of the mind; it often 
manifests itself as an insanity. Psychoses result from both 
hereditary and external agencies. Parasitic infection is one 
frequent cause, and injury to the head another. Preventable 
psychoses are often secondary to diseases which have first 
involved other functions; prophylactic measures are taken 
up in the other connections. 

Mentally Active Drugs.— Mental activity is variously 
stimulated or depressed by the action of certain drugs. 
Under stimulant influence the mind increases in efficiency, 
and the quality and amount of work done improves. Under 
depressant influence it loses in efficiency, resulting in less 
and poorer work. Nicotine, caffeine and alcohol have come 
into wide use, through their effect on the mind; except in the 
case of the last, their influence is temporary and they have 
affected but little the health of average users. 


174 


THE FOUNDATION OF HEALTH 


Athletes, especially while in training, do better without 
alcohol or any other of the drugs mentioned. Most authori¬ 
ties are agreed that children develop better without them; 
periods of artificial stimulation or depression could well alter 
the growth of the mind. There is no evidence that the almost 
universal tea drinking among Chinese children hurts them, 
but comparisons are hardly justified; the oriental mind is 
different from ours, and the tea made there is weak. 

Caffeine .—The use of tea or coffee is almost world-wide. 
Many peoples have found them desirable, though in excess 
they have proved to be undoubtedly bad. There are persons 
who cannot sleep or are otherwise disturbed after taking very 
moderate amounts. The view, prevalent in some quarters, 
that seemingly well-tolerated quantities do injury would 
appear extreme. The caffeine, which gives these drinks their 
stimulating effect, improves for a while the mental activity. 
One does more and better work, and sensations of fatigue 
are diminished. If tire should develop but not be felt as 
fatigue, the likelihood of overworking and perhaps straining 
the mind would increase; such a claim has been made in the 
case against coffee. This would suggest that those subject 
to insomnia or other symptoms of mental strain ought to be 
cautious. 

Coffee and tea contain tannin as well as caffeine; this has 
no mental activity, but to some persons is constipating. 
The flavor and aroma of coffee is due to the harmless volatile 
oil, caffeol. 

Nicotine .—Nicotine is considered depressing to the mental 
faculties, but as emotions are soothed there might be relief 
from worry or annoyance and therefore improved reasoning 
capacity. In very moderate dosage it seems to do no harm. 
Mental effect of the nicotine varies with the amount con¬ 
sumed; if the same degree of influence is to be felt as time 
goes on, the amount must usually be increased. Cigarettes 
and dry cigars supply the smallest dosage of nicotine per 
given weight of tobacco, as the rapid combustion partly 
oxidizes the drug. Moist cigars burn less rapidly, and more 
nicotine is sucked in from the heated area next the fire. 

Poisonous substances other than nicotine are also present 


THE MENTAL PROCESSES 


175 


in tobacco, but the small quantity taken in by the smoker is 
not ordinarily harmful to him. Effects of smoking on organs 
other than the nervous system are thought to include a 
hardening of the bloodvessels, but the evidence for this is 
hardly conclusive. Users of tobacco with syphilis sometimes 
appear to have a particularly low resistance to cancer of the 
mouth, if a broken tooth should keep the membrane raw. 

AIcohoL —Alcohol also depresses. In this case the orderly 
reasoning processes are interfered with, as is noticeable from 
the beginning of the influence. For a time an emotional 
activity supplants the lost reasoning power; one urge to 
alcoholism is the enjoyment included among the emotions 
stirred up. The emotional stage has been called one of 
stimulation, but the mental capacity is depressed during this 
stage and throughout. As the alcoholic effect increases, the 
depression deepens and sleep comes on. 

The conspicuous harm which alcoholism does to a person 
is the reduction in his mental capacity while wholly or partly 
under the influence. There are also more lasting effects, 
though these have often been exaggerated; they prove 
greater or less according to individual resistance. Desire for 
alcohol tends in all cases to increase, and in those of a certain 
inherent make-up it readily passes beyond control. The 
mental inferiority exhibited by some drunkards when entirely 
off of drink is not altogether the result but largely the cause 
of the drunkenness. 

Such inherited traits as lead one to alcoholism are quite 
independent of the use of alcoholics by his forebears. Alco¬ 
holism of the parents does, however, have a congenital effect 
other than hereditary; this might conceivably impose some 
desire for alcoholics. The baby’s constitution is in various 
respects weakened by prolonged alcoholic excesses of the 
parents before its birth. 

Psychoses (delirium tremens, et al.) sometimes result from 
the long use of alcoholic drinks. Injurious effects occur also 
to the liver (alcoholic cirrhosis), the stomach (alcoholic gas¬ 
tritis), and other organs. The resistance to various diseases, 
notably pneumonia and sunstroke, is materially lowered by 
continued alcoholism. Alcoholic beverages not made by 


176 


THE FOUNDATION OF HEALTH 


experienced and responsible manufacturers, particularly the 
distilled liquors, develop compounds which are much more 
poisonous than the alcohol; the effects of “moonshine” 
poisoning are dive largely to these other compounds. 

Mental Tire.— Mental sluggishness comes also from sources 
other than hereditary traits, diseases of mind, and drugs. 
Excessive' warmth of the room, or the ingestion of a heavy 
meal, impedes the activity of the mind by a reduction of the 
brain’s blood supply. Nutritional disorder or physical ailment 
of any sort also impedes mental activity, as does physical 
or mental tire. Mental tire can often be explained as the 
depression to nervous elements effected by an action of waste 
products from any working tissue. The nerve cells feel a 
tiring effect of their own activity as well. 

An average of about forty-five minutes of concentration 
on an unfamiliar but fairly interesting subject begins to tire 
the adult’s mind. Children tire sooner, a young child in 
about fifteen minutes. On a very familiar subject, for which 
the thought channel is well developed, one concentrates 
much longer without fatigue. In this case, the involvement 
of a larger number of associated nerve cells means less load 
per cell; any one cell functions less continuously. An expert 
might never show tire from working on his own specialty. 
Functioning causes nerve cells to shrink in size and obliterates 
the microscopical appearance of some well-staining granules 
(Nissl bodies), which are not to be found in a tired cell but 
reappear after rest. 

Retarding Emotion.— Association paths which are too 
greatly weighed down by the various depressing influences can¬ 
not do their work. An indication that they are too depressed 
for the activity being demanded of them is an accompani¬ 
ment of unpleasant emotion. The backward student who 
strains over studies that he cannot master becomes irritable 
and disagreeable, but if the study is transferred to subjects 
of greater appeal he drifts back into a pleasant companion¬ 
ship with others. Physical defects which react on and weary 
the mind lead similarly to an irritable or worrisome disposi¬ 
tion, as does mental tire from any cause. Nightmares and 
fear of the dark assail the child most when it is tired. 


THE MENTAL PROCESSES 


177 


Repeated recurrence of fear, jealously, prejudice or anger is a 
sign of disorder, physical or mental, which needs diagnosis 
and would often profit by treatment. 

Such emotions are themselves a depressing influence; 
they not only indicate but serve to increase a mental handi¬ 
cap. Nothing fatigues the mind more quickly than this sort 
of emotions. They also interfere with mental growth by 
crowding out constructive emotion. Sentiments into which 
retarding emotions are established with the reasoning pro¬ 
cesses exclude others which incorporate desirable emotions; 
a harmful anxiety excludes the really serviceable hope. 

Constructive Emotion.— The constructive and healthy 
emotions are such mild and not unpleasant ones as enthu¬ 
siasm, confidence, determination, and happiness. Not only 
does an enthusiasm for something carry the mind into an 
understanding of it, but this enthusiasm is responded to from 
the minds of other persons and leads into wider social rela¬ 
tionships. The generous and optimistic person is the person 
with many friends, and this companionship broadens his 
view to include other than selfish standpoints. A mental 
breadth and an improved position with the rest of the world 
develops. 

Children receive much of their training from playmates 
and ought to be strongly discouraged from living to them¬ 
selves. The pleasant and broadening emotions of companion¬ 
ship should come early into sway. Companions are prefer¬ 
ably of the child’s age, and disciplined, for by setting fashions 
they might make either good or bad impulses seem desirable, 
but only the really demoralizing companion could be worse 
than none. 

A timid reserve might easily be overcome in early child¬ 
hood, before it is a fixed habit. Otherwise it leads more and 
more toward seclusion, and thereby develops into a worse 
emotional reaction. In place of such friendly admiration of 
others as to widen social connections, there comes a jealousy 
which tends instead to narrow them. Great mental breadth 
is attained only with constructive emotion. 

Emotional Excess.— Violent emotion of any type is a hin¬ 
drance. It upsets the mind’s trained control over the body. 

12 


178 


THE FOUNDATION OF HEALTH 


For that matter, it upsets involuntary impulses in control 
of the body as well; with fright, anger or grief, the skin 
blanches, tears come, and digestion is interfered with. The 
orderly mental functions may be entirely supplanted by 
strong emotion; bad judgment and unsound reasoning are 
almost to be expected at times of great anger or hysterical 
joy. The figurative conception that an emotion’s attendant 
impulse can sweep open new thought channels in the brain 
leads to another, that if too excessive such impulse might 
tear through some short cut to a resultant bodily activity. 
Violent emotion is a poor guide. Another bad effect is that, 
like the undesirable type of emotion, it engenders fatigue. 
Orderly conscious activity is not nearly so tiring. 

Emotional Discipline.— The training of emotion consists 
in its subordination to the more orderly mental processes, 
and in the crowding out of its disagreeable forms. The ease 
with which emotional excess can be controlled depends on 
how well the mind has accommodated itself to the environ¬ 
ment. An emotion’s intensity is proportional to the novelty 
and uncertainty in the situation faced. A mental process 
which had been trained to direct the conduct in such situa¬ 
tions would be less subject to emotion. A hold-up does not 
frighten the plain-clothes policeman, who knows intuitively 
what to do if held up; but most persons, whose intuition says 
all at once to give in, to fight, and to run, get scared. 

A sustained sentiment—pride for instance—which fre¬ 
quently calls forth an emotion is likely to represent a rela¬ 
tionship which remains very uncertain. The pugilistic 
champion retains a pride in his ability to overcome contenders 
but he is not proud of his ability to overcome cripples; the 
first relationship is not a settled one and the second is. The 
same obtains with the opposite type of sentiment. Thorough 
mental training of any sort adjusts one to the environment 
and tends to eliminate uncertainties; this lessens the effort 
necessary to control emotionalism. 

Habitual fear or anger harms particularly the mind during 
childhood. At this time above all others the influence of 
mildly pleasant emotions is needed. The worst feature of 
severe punishment is the frightened anticipation of it. The 


THE MENTAL PROCESSES 


179 


apparent need for punishment arises to a great extent from 
weakness and carelessness in the child’s previous training. 
Continual emphasis on what is right with such correction 
as to enforce it regularly makes severe punishment unneces¬ 
sary. The anticipation begins after the offense anyway, 
and leads to deception more often than to good behavior. 
Anger as well as fear might tend to dominate the child’s 
mind if allowed to become habitual. With spoiled children 
this occurs; if their playmates are contrary they yell for 
mother, and if they want too much candy they have a temper 
fit. Uniform futility of such outbursts would disillusion 
them and lead to a better mental reaction. 

Aids to Mental Impulse.— Productive mental concentration 
follows a mild and constructive emotion, and whatever 
depressant influences would upset this state of mind retard 
it. The attention must steer away from anything that would 
arouse violent emotion or bad types of emotion. If too great 
warmth of the room is felt as a dampening of the enthusiasm, 
the room is cooled until the failing interest revives. Physical 
disorders which depress the activity of the mind should have 
been corrected when first noticed. When the mind tires 
itself out, the interest and progress decline until after a rest. 

The rest for a tired mind comes with a shifting of the load 
of work from the tired nerve cells. Change of the subject 
worked on shifts the load partially; some of the same associa¬ 
tion cells and some others are then employed. Mental recre¬ 
ation, in the form perhaps of a visit to the “ movies”, gives 
greater exchange of the cells at work and correspondingly 
greater rest. Recreation by outdoor games or other physical 
exercise transfers the work still more and is more resting. 
Sleep takes off more of the load than anything else we can do. 

Sleep.— Adults usually need a night’s sleep of from eight 
to ten hours; many retain a clear mind throughout the day 
with a good deal less. Their preferences in the matter can 
hardly be criticized unless effects of tire appear. Children, 
on the other hand, should be assured plenty of sleep regard¬ 
less of how they feel about it. Sleep is most essential during 
the early development of the brain. A baby at first sleeps 
all but a few of the twenty-four hours; this period should 


180 


THE FOUNDATION OF HEALTH 


not decrease too fast. The child should have about eighteen 
hours at a half year, fifteen at one year, and twelve at four 
years of age. The period is then shortened by a quarter of 
an hour each year through childhood. It is an unwise desire 
of many children that sends them to bed too late for this 
amount of sleep. Hours for bedtime and rising are best set 
arbitrarily; for young children, part of the sleeping period is 
best made an afternoon nap. 

Sleep comes when the diversity of sensations received is so 
cut down that consciousness is not needed to guide their 
impulse through the brain. People lie down in a dark, quiet 
room to avoid environmental stimuli, and perhaps count 
sheep to narrow down those stimuli which spring from the 
memory. Other factors behind sleep and sleeplessness crop 
up, which are confusing. Sleep is not yet understood. 

Insomnia.— Insomnia often means an overtiring of the 
mind or of the eyes. Physical defects or disorders aggravate 
the tendency. Heavy meals in the evening, or too much 
coffee, often predispose. A common formula for inducing 
sleep, in addition to the avoidance of these things, is as 
follows: The troubled person takes a half hour’s recreation, 
preferably outdoors, just before bedtime; then, without any 
more reading or mental work, he takes a warm bath and 
goes to bed. The bedroom is in the meantime cooled off 
to the lowest temperature compatible with comfortable sleep. 
Another most important item is that bedtime be regularly 
at the same hour. 

Symptoms of Tire.— It is often difficult to distinguish clearly 
between tire of the mind itself and tire of the eyes. If the 
eyes have been found normal or properly fitted there is little 
reason for making the distinction, for as a rule the mind and 
eyes must work together or be rested together. There is no 
sign for absolute localization of tire to the mind, unless it 
be greater difficulty in mental concentration on one problem 
than on another equally familiar one which taxes equally the 
same senses. 

The first suggestion of tire is a diminution of interest and 
disposition of the mind to wander. The progress of the work 
done soon declines in speed and accuracy, unless the mental 


THE MENTAL PROCESSES 


181 


effort be forcibly increased. Later come unpleasant emotions 
of dislike and irritability, and then the progress slows down 
quite sharply. Perhaps an insomnia results, or headache. 
These symptoms accompany the growing tire from mental 
work. 

Toleration of Tire.—The extent to which the mind can 
tolerate fatigue without suffering from it varies with individ¬ 
uals. The limit in most children is low. Mental work in 
early childhood should not be carried beyond the point of 
spontaneous interest. That safe for the baby is even less; 
the baby laughs and kicks when shown attention and may 
continue to do so until it is quite tired. The practice of 
entertaining a baby until it tires and cries, and then of 
bouncing it about to cheer it up, strains the little mind that 
so greatly needs rest instead. 

Mental activity in the adult, or even the older child, need 
not necessarily be limited by the symptoms which suggest 
beginning tire. An abatement of interest and enthusiasm is 
hardly a danger sign, for good work is done by minds'tired 
beyond this point. Good work is done on problems which 
were not interesting from the beginning; the mind channel 
of high capacity yields enthusiasm when called on, but that 
of lesser capacity may also get results. 

Mental Strain.—Insufficiency of a mind channel’s capacity, 
from any of the several causes, may result in such overloading 
as to strain it. The faculty may have been neglected or have 
proved incapable of development, or it may be worn down 
by emotion, tire, sickness, alcoholism, or other influences. 
It is then unable to make the environmental adjustments 
demanded of it, and is strained by the attempt. Mental 
strains are due less to great volumes of work by the mind 
which is in condition than to ordinary work by the mind 
which at the time is unsuited for it. 

The earliest symptoms of mental strain are those of con¬ 
tinued tire. An occupation slowly reduces the ability to 
concentrate, and changes the emotional reaction. Instead 
of confidence and enthusiasm in planning the work’s progress, 
there is anxiety about its outcome. There also appears a 
tendency to insomnia and to irritability, and sometimes to 


182 


THE FOUNDATION OF HEALTH 


headache or dyspeptic symptoms. When these symptoms 
are aggravated and accompanied by uncontrollable emotion 
and even perceptional disturbances, the condition becomes 
that widely referred to as nervous prostration or breakdown. 
Nervous breakdowns have resulted from physical ailment, 
and from doggedly following distasteful occupations or those 
with uncertainties entailing much anxiety. 

Such strain may simulate the hereditary condition of self- 
centered incompetency spoken of as a form of neurasthenia. 
The employed thought channels in persons with this disease 
are inherently subject to tire. The mind may in some cases 
be as well suited to housework, for instance, as was that of 
fortunate ancestors with this to do, but for the life which 
the patient wants to lead the channels simply are not ade¬ 
quate'. The symptoms are a continuous sensation of fatigue, 
inability to work without tire, and limited capacity for effi¬ 
cient mental activity; also there is insomnia, worry, and 
excessive emotionalism. Persons who naturally are not such 
misfits in the environment, and whose minds are suited to 
their walk in life, can be fatigued by anxiety or physical 
disease into a condition which appears for a time quite 
similar. 

Management of Strain.— Relief from severe mental strain 
requires at the start complete rest. Any cause for fear or 
worry, or any contributory physical ailment, is to be removed. 
After an interval of quiet resting come regular periods of 
concentration, which at first are short but gradually increase 
until normal study is possible. As interest attaches to the 
healthiest of the thought channels, the subjects for study are 
selected according to the interest displayed. Periods of 
concentration are limited to the duration of the interest. 
The obstacle that comes up before unfortunate neurasthenics 
is that nothing is discoverable within their sphere of life 
which really interests them. 

Spoiled Children. — An analogous condition of strain is found 
in the undisciplined child. This condition may result from 
careless training or from inherited incapacity for mental 
discipline—though the latter is very rare. According to the 
intensity of the symptoms, the child is referred to as spoiled, 


THE MENTAL PROCESSES 


183 


as strong-willed, or as nervous. Essentially selfish, ignoring 
any rights of others, fatigued even on rising, sleeping neither 
readily nor soundly, given to superficial sorrow, anger and 
fear, and to giggling, crying and temper fits, the pronounced 
case simulates in miniature the neurasthenic. Adjustment 
to the surroundings is difficult for it. 

Strain of the young mind is often through insufficiency of 
sleep, resulting because the child is permitted to stay up too 
late. It is often due to physical defects, or to some undis¬ 
covered and mild illness. It may also result entirely from the 
mental confusion incident to careless discipline and from a 
non-comprehension by the child of its proper relationship 
with others. Spoiled children rapidly improve when their 
relationship with others is made clear to them, that is actually 
clear, and when other causative factors are controlled. If 
not put right at home as to their relative importance in the 
world, they usually are by their companions, sometimes with 
a vengeance, later. The only hopeless cases are the few with 
inherited incapacity for discipline; these pass on into a self- 
centered adulthood, often with the neurasthenic charac¬ 
teristics just described. 

Mind in Childhood.—The earliest step in the child’s mental 
development is a collection of sensations, from which can be 
built later the complex association processes. Variation in 
childish experiences affords the opportunity for sensations, if 
the sense receiving organs function well. During early child¬ 
hood a confined life, or one without companionship, is likely 
to prove a greater handicap than are defects of the receptive 
organs. The sense of touch is never impaired, and through 
it the little child does most of its sensing; the eyes are rarely 
impaired enough to interfere with the visual demands of 
that age. 

On seeing a toy the child must feel it; then he begins to 
know it. View of another toy suggests something different, 
and he proceeds to handle that one. The frying pan and the 
stove blacking offer something still different, and invite the 
child’s study. The fire remains fascinating, until he has 
been burned. This groundwork of sensation affords material 
for the first simple associations. 


184 


THE FOUNDATION OF HEALTH 


Early Training.— Prior to school age, the natural inquisitive¬ 
ness is sufficient urge to learning. With very little encourage¬ 
ment the child proceeds to store in and associate simply 
together the sensations. The child is not prepared always 
to select well in its search for new experiences, and needs the 
judgment of an elder who better understands and is ready 
to pass very certainly on its problems. Limitation to the 
childish investigations are to be made unwaveringly if at all, 
though the fewer such limitations the better. Too great 
repression changes the emotional reaction from a happy to 
an unhappy one, which is a hindrance to mental growth. 

Another essential to the young child’s training is a clearing 
away of the confusion which so easily creeps into the unskilled 
attempts at association. A huge and disordered mass of 
impressions is taken in for registration in the memory, and 
these impressions are to be put into a simple relationship. 
Parents aid the child to do this by answering such questions 
as are impelled by the awakening curiosity. Patience and 
quiet pleasantness of the mother stimulates mental health in 
the child, and she serves the child better by thinking of her 
own comfort and rest than by working for it to the point of 
fatigue and exasperation. 

Discipline.— The child cannot yet be made to understand 
some conditions which it encounters, but it can be made to 
see more clearly what these conditions are. The necessity 
for yielding to authority and the distinction between sug¬ 
gestion and command are not grasped unless taught. A 
little boy told to lie down but not made to lie down is 
impressed about as he would be by a suggestion that he play 
with his teddy bear. Orders which may or may not call for 
obedience are cruelly confusing. 

Property ownership is just as unintelligible until taught. 
Children who get everything they want are given the impres¬ 
sion that everything is theirs on demand, though some things 
perhaps must be screamed for louder than others. This 
does not occur with the child who, on asking for a thing, is 
always told truthfully at the outset whether or not he can 
have it. 


THE MENTAL PROCESSES 


185 


Training at School Age. The training of the .somewhat 
older mind, which is entrusted to the teacher, requires but 
supplementary attention in the home. Moral training and 
discipline comes best from the parents. Parents who deprive 
their children of discipline in the hope of encouraging origi¬ 
nality and initiative make them careless of others and men¬ 
tally unstable, but they do not make them any less imitative. 
Such children imitate their companions, probably the worst 
of them, and continue to do so until late in childhood, when 
they reach the usual age for true initiative to appear. 

The home may also be expected to put the child into con¬ 
dition physically to get the most out of its school work. 
The most handicapped among school children are those whose 
eyes are quickly tired through defect, who cannot hear all 
that is being told, or who cannot become interested because 
they are tired, improperly nourished or otherwise uncom¬ 
fortable. That physical ills retard mental development is 
amply demonstrable. Physical defects are always distrib¬ 
uted most prolifically among the poor students and least so 
among the good ones; their correction puts backward chil¬ 
dren within a year or so among those of higher scholarship. 
For correction of such defects, the school must have the 
cooperation of the home. 

Reading. * 

General , H. S. Williams, Chapter V. 

Mechanism of the Conscious Processes, Herrick, Chapter 
XXI. 

Mental Organization and the Emotions, Angell, Chapters 
XVIII, XIX, XXI, XXII. 

Neurasthenia, Pyle, Section by Courtney. 

Psychoses and Mental Deficiency, Cabot, Chapters IX 
and X. 

Cerebral Stimulants and Depressants, Winslow, Chapter I. 

Effects of Alcohol and Nicotine, Fisher and Fisk, Supple¬ 
mentary Notes, Sections IV and V. 


* See bibliography for titles and publishers of books. 


CHAPTER XI. 


PHYSICAL EXERCISE. 

Physical exercise has four prominent purposes. It 
develops the nerve-muscle mechanism; normal growth or 
the correction of any defect of this mechanism requires 
exercise. It maintains indirectly the health of the other 
functions of the body. It aids mental development. Finally, 
it is a most effective form of recreation. 

Exercise taxes many of the body’s functions and if not 
excessive strengthens them all through an increase of their 
resistance to such strain. Most organs tend to develop 
when used and when not used to waste away, or atrophy. 
The condition of the weakest organ involved gives the index 
of how much exercise is safe, for the strain that exceeds 
any function’s resistance does definite harm. 

Muscles.—About half of the body, by weight, is muscle 
tissue. There are three kinds of muscle. That for the volun¬ 
tary movements of the body consists of long spindle shaped 
fibers, each striped crosswise and containing indistinct nuclei. 
Conscious processes of mind control the nerve impulses to 
these muscles. Another type, which is not striped and is 
independent of voluntary control, is called smooth or invol¬ 
untary muscle. The muscular coat of the intestine is an 
instance. The third or cardiac type, which consists of short, 
broad fibers, makes up the muscle of the heart. 

Muscular Growth.—Muscular action, whether voluntary or 
involuntary, must be brought about by nervous impulse. 
In response to the impulse, a contraction of the fiber pulls 
in on the attachments at either end. The necessary energy is 
derived from the consumption of fuel foods, and as the activ¬ 
ity tends to wear out the muscle, protein food also is required 
to keep it in repair. The tissue formed in repair exceeds in 


PHYSICAL EXERCISE 


187 


amount that destroyed by the activity, so the muscle becomes 
larger. The fibers increase in size and number. 

The volume of muscle tissue increases most through very 
heavy work, which tears down the muscle greatly and calls 
for correspondingly great repair during the rest which follows. 
This is not necessarily of advantage, for voluminous muscle 
tissue is of real service to but few; it handicaps others by 
adding to the load on the heart. Pneumonia seems sometimes 
to strike big and husky men hardest, presumably because 
of an inability of the heart, overworked already for the 
supply of so much muscle tissue, to take on the additional 
strain caused by the disease. 

The older gymnastics which aimed to enlarge the muscles, 
particularly of shoulders and arms, is losing in popularity 
among physical directors. In ordinary pursuits these muscles 
do not need to be powerful, and the piling on of needless 
muscle tissue is bad. Such exercises instead as develop the 
trunk muscles are receiving more attention than formerly. 

Nerve Control.— Development of the neuro-muscular system 
is something more than the building of muscle tissue. Of 
greater importance is the building of a nervous driving force 
to operate the muscles. The first attempt to paddle a canoe 
or play tennis is clumsy and fruitless, though superfluous 
muscular energy is expended on it. The nerve impulses are 
neither timed right nor sent entirely to the right muscles. 
Training coordinates the motions and eliminates superfluous 
ones, and thereby builds effectiveness. 

The nerve control which leads to this proficiency comes 
better by many repetitions than by spasmodic, strenuous 
exertion. The weight lifter has more conspicuous muscles 
than the wrestler, but is less capable of continued work 
because of his poorer nerve control of them. Such control 
develops from a long and consistent course of moderate 
exercises, each begun in a rested condition, and does not 
develop from an occasional overtiring. It is the continuance 
of regular exercises over a long period of time that can be 
counted on to impart strength and skill. 

Exercise of the Baby.— The baby’s exercises bring about 
nervous control just as they do a development of muscle 


188 


THE FOUNDATION OF HEALTH 


tissue, a fact lost sight of by many who insist on trying to 
help the baby gain strength. The formation of nervous cor¬ 
relations proceeds after a perfectly ordered plan, each accom¬ 
plishment paving the way for the next. The baby first uses 
simple arm and leg movements, later grasps things, and still 
later rolls. After from about six to nine months it sits up, 
and within the year begins to walk. Any attempts by adults 
to hurry along one or another of the baby’s activities tend 
only to upset the plan. 

The baby should be allowed to follow its natural inclination. 
A backwardness is not through want of instruction, and it 
may be a preventive of deformity in unrecognized rickets. 
The following of the natural inclination should not be ham¬ 
pered by confining clothing, nor during late babyhood by 
too much penning up in bed. Much outdoor play is to be 
encouraged. 

Corrective Exercise.—Corrective exercises are those designed 
to build up some specific neuro-muscular coordination. If 
certain muscles have failed to develop as they should, it 
may be possible to correct the defect through certain exercises. 
Functional defects of posture are managed through corrective 
exercises. Or again, some of the muscles may need extra¬ 
ordinary development to compensate for the loss of function 
by others. If a thumb has been destroyed, the remaining 
muscles of the hand need added development in order to 
function without it. The tedious corrective exercises and 
other aftertreatment of infantile paralysis have for their 
aim the equipment of the muscles which are left to compen¬ 
sate for those left powerless by the disease. 

Posture.—The posture of the body depends largely on the 
relative strength of different groups of muscles. Posture is 
the position in which the muscles hold the body, a more or 
less upright position in the case of human beings. One great 
advantage of the erect position is the freedom allowed the 
upper extremities. If part of the musculature can strengthen 
sufficiently to hold the body in position, the rest is left free 
for other work. The posture which calls only on the neces¬ 
sary muscles has the chest somewhat forward and the head 
and hips somewhat back; a slouching posture hangs part of 


PHYSICAL EXERCISE 


189 


the weight on other muscles as well. Assumption of a good 
posture is best attained by the forced attempt to raise the 
top of the head as high as possible, without raising the heels. 

Gauge of Posture.— The posture may be gauged simply 
and well by the apparent axes of the body. The true axes 
should pass vertically for the head and neck, downward and 
forward for the back, downward and backward for the pelvis, 
and downward and slightly forward for the legs. The com¬ 
bined or apparent axes are vertical for the trunk as well as 
for the head and neck. On side view an imaginary vertical 
line dropped from in front of the ear to slightly in front of 
the middle of the foot should parallel the apparent axis of 
the head and neck, and also that of the trunk of the body, 
and it should pass just in front of the tip of the shoulder 
( Bancroft’s test). Viewed from in front, the body should 
appear symmetrical. 



Fig. 18.—Temporary splint. 


Fractures and Dislocations.— Deviations from this postural 
standard are by defects of skeleton or of muscle. Acute 
postural injury includes fractures, dislocations or sprains. 
Dislocation of the finger can often be reduced by pulling 
straight out on the finger. Fractures, or dislocations of 
joints other than of the fingers, are better given first aid and 
left for the care of the surgeon. The greatest possible rest 
is afforded the part, and pain relieved through methods 
already gone into. An injured tissue is rested if the member 
is propped into a position by sandbags or other supports, or 
if it is bandaged firmly to a support of some sort. 










190 


THE FOUNDATION OF HEALTH 


A badly injured leg may be put at rest in a roller splint. 
The latter is made by spreading out on the floor a suitable 
sized piece of fabric, and rolling in the two ends about boards 
until the rolls come almost together. Turned over, this 
affair can be placed under and fastened about the injured 
leg and gives firm support. The contrivance was made 
originally with a blanket on the battlefield, and was called 
the blanket splint. 

Prevention of Deformity.— The prevention of joint and bone 
deformity is by proper treatment not only of local injury 
but also of some general diseases. Spinal tuberculosis requires 
prolonged rest of the spine in a straight position, if hump¬ 
back is to be avoided. Rickets causes several bony deform¬ 
ities, and the legs may be badly bowed or otherwise 
disfigured if the weight of the body is put on them while the 
disease is active. Many of the babies who are backward 
about sitting up and walking prove to be retarded by rickets; 
by urging them to walk one would induce deformity. Avoid¬ 
ance of subsequent deformity is a consideration in the treat¬ 
ment of several diseases. 

Spinal Curvature.— Functional defects of posture are those 
due to low tone of the muscles. Assumption of the upright 
position by man throws greater strain on the musculature 
of the back than does the horizontal position of other animals. 
If the strained muscles yield, postural defect results. Weak¬ 
ness in the muscles of the lower back, or lumbar region, leads 
the child in school to support the upper as well as the lower 
part of the body, and so he slides down in his seat or slumps 
forward on his desk. The use of badly fitting school desks 
aggravates the curvatures, and an important item of school 
hygiene consists in adjusting the height and shape of desks 
to the occupants. 

Curvature of the spine is positively counteracted only 
by the building up of the musculature. Prevention or cor¬ 
rection of curvatures is by such exercise, rest, and nutrition, 
as will build strong back muscles. Such gymnastics as somer¬ 
saults or lifting exercises when in a standing position develop 
these muscles. Ordinary outdoor play is perhaps the greatest 
preventive of curvature. Girls average a weaker muscula- 


PHYSICAL EXERCISE 


191 


ture and more spinal curvature than boys; they need out¬ 
door play just as much. 

Varieties of Curvature .—General fatigue of the body relaxes 
the tone of its postural muscles. The head and shoulders 
droop forward and the chest sinks back. Tuberculosis and 
other debilitating conditions which induce fatigue are char¬ 
acterized by this posture. Its habitual assumption predis¬ 
poses to a permanent spinal curvature with backward con¬ 
vexity {kyphosis). The curvature is accompanied by a for¬ 
ward inclination of the head and neck axis, by an apparent 
flatness of the chest, and by a rounding of the shoulders. 
A sitting posture which rests the hips on the front edge and 
the shoulders on the back of a chair or bench promotes 
the same deformity. 

A spinal curvature of forward convexity ( lordosis) is said 
to result sometimes from attempted overcorrection of the 
tendency to backward curvature. Very fat persons normally 
assume this forward curvature to bring their excessive weight 
back over the center of gravity. Lateral curvature {scoliosis) 
results from a muscular weakness more pronounced on one 
side than on the other. It is promoted by habitually resting 
the upper part of the body on one arm or one shoulder. 
Carrying books under one arm curves the spine laterally, 
and might also promote the deformity if the load is carried 
always on the same side; if the sides are alternated, the effect 
on posture would be good. Occupational curvatures, such 
as that which sometimes develops in postmen to support 
a load on one side, might equip better for the work to be done 
than a symmetrical posture. 

Posture of the Foot.— The posture of the foot is altered more 
or less by most of the accepted footwear of civilized peoples. 
The best shoe, from a postural point of view, is one of which 
the inner margin follows a straight line from beside the heel 
to beside the great toe, which is broad across the toes, and 
has a flexible sole and a low heel. A shoe of this shape per¬ 
mits the foot to function naturally, and should be insisted 
on for the developing foot of childhood; older people can 
often choose footwear from other considerations and suffer 
no harm thereby. The high heeled shoe alters also the general 


192 


THE FOUNDATION OF HEALTH 


posture; many women are impressed quite favorably with the 
alteration. It increases the height, throws the hips slightly 
forward, and lessens the body’s freedom of movement. 

Weak Arches.— The shoe which presses in on the great toe 
forces the axis of the foot outward beyond the body’s center 
of gravity, and by throwing the weight toward the inner 
margin of the foot presses down on the longitudinal arch. 
Walking with the toes out has a similar effect. Toeing in 
brings the axis beneath the center of gravity and permits 
firmer support; this operates against the falling of the arch. 
Lowering of the arch, or flat-foot, may or may not be asso¬ 
ciated with local discomfort. 

The strain spoken of as an acute breaking of the arch is 
indicated by a rather sharp soreness along the inner margin 
of the foot, which makes walking painful. It is not actually 
a giving way of the fascia of the arch at all, but is due rather 
to a weakness of muscles with consequent rolling in of the 
foot, lowering of the arch, and local congestion with swelling. 
Toeing in relieves the pain somewhat. Temporary relief is 
gained by an adhesive tape support. The arch is forced 
down into an eighteen- or twenty-inch strip of the adhesive 
tape as into a stirrup, and the two ends are then pulled, 
crossed over the ankle, and stuck to either side; several such 
strips are applied. Strain of the transverse arch, suggested 
by a similar pain in the fore part of the sole of the foot, is 
eased by an adhesive tape bandage wrapped firmly about this 
part of the foot. Supports of various types with which shoes 
are fitted also take off the strain. Supports for the foot are 
but emergency measures, and their continued use is not 
desirable except for incurably weak feet. 

Development of the foot is hampered by arch-supporting 
shoes. The play of the muscles is interfered with and as 
strength of the foot is unnecessary it does not develop. 
Walking or running in soft soled gymnasium shoes, or bare¬ 
foot, affords strengthening exercise to the muscles holding 
up the arch. A more specific foot and arch exercise consists 
in standing on the edge of a chair with the front part of the 
feet protruding, and alternately contracting and relaxing the 
muscles of the soles. Another is the repeated raising and 


PHYSICAL EXERCISE 


193 


lowering alternately of the heels or of the toes while standing. 
Almost any regularly continued exercise of the foot strength¬ 
ens the arch; it is the exertion following relative inactivity 
that is likely to strain. 

Exercise and Health.— The activity of organs other than 
nerves and muscles depends just as much, though less directly 
on physical exercise. The circulatory system must speed up 
for the supply of more oxygen to the working muscle, and 
by doing so it calls into greater activity some other parts. 
Many organs tend to become sluggish in a life routine from 
which active exercise is excluded. The laborer’s health is 
preserved by his day’s work, but the office man’s sometimes 
is not. While some who lead sedentary lives retain the health 
necessary for their mode of life, there are others who acquire 
a tendency to obesity, to constipation or to headache, unless 
they take additional exercise. 

Circulation of the Blood.— Next to that of the skeletal neuro¬ 
muscular system, the circulatory function is the one most 
directly affected by physical exercise. Oxygenated blood 
passes from the lungs to the cavities of the left part of the 
heart, the muscle of which repeatedly contracts and pumps 
it along in a direction maintained by the heart valves. This 
force from the heart carries the stream through tissues, food- 
supplying organs, and eliminating organs, and back to the 
cavities of the right part of the heart. The oxygen is mean¬ 
time taken out for energy production, and the right heart 
forces the stream to the lungs for more. The blood must 
flow faster to satisfy a demand from working tissues for an 
increased oxygen feed. 

Metabolic waste products stimulate to added work the 
muscles of the heart and bloodvessels. The heart beats 
faster and the blood-pressure rises. The readiness of this 
reaction is one of the practical indices of circulatory efficiency. 
If a healthy person hop some 40 feet, the pulse-rate increases 
on the average about 5 beats per quarter of a minute, and if 
he then stand still it returns within a minute or so to the 
original rate. The heart which is in good condition from 
regular exercise might return to normal in a half-minute 
or less, while in one more sluggish the reaction is delayed. 

13 


194 


THE FOUNDATION OF HEALTH 


In general, the vascular change brought about by exercise 
transfers blood from visceral vessels to the vessels of the 
skeletal muscles, and in the latter it accelerates the flow. 
To provide for such an increase of blood supply to the working 
muscles the local vessels dilate, due also to an effect of the 
waste products. 



Fig. 19.—Course of the circulation. 


“Charley Horse.”— Very strenuous exertion of a muscle, 
especially in those unaccustomed to it, is sometimes brought 
to an abrupt halt by a sharply acute and incapacitating pain 
and stiffness in the muscle. The pain often follows a blow 
to the strained muscle. Spasms incident to the readjust¬ 
ments within the muscle have caused blood to congest in 
the muscle’s vessels; these bloodvessels are sometimes torn 
and there is bleeding into the tissue. The part is better 
rested at first than manipulated; too active manipulation 




PHYSICAL EXERCISE 


195 


could make matters worse. An application of heat, by 
hot-water bags or wet dressings, and subsequently careful 
massage, aids recovery. The massage should be light and 
superficial until the muscle has entirely relaxed. 

Muscular Fatigue.— Another local discomfort results from 
an accumulation of carbon dioxide and other waste, which 
depresses the tissue. It produces a sense of fatigue, and 
even of aching and stiffness in the muscle. This discom¬ 
fort is relieved by rest, an application of heat, and massage. 
The massage most useful for this purpose is in a direction 
toward the heart, and consists in a deep, kneading manipu¬ 
lation of the muscle tissue. Such manipulation aids the ven¬ 
ous and lymphatic circulation to dispose of the accumulation. 
The lymph carries off much of the tissue waste which follows 
a hard workout. The flow of lymph is due almost entirely 
to pressure against its vessels, and is promoted not only by 
massage but by the exercise itself. 

Varicose Veins.— The blood in the veins has a low pressure 
and a slow current, as its flow has been greatly reduced by 
the small caliber of the capillaries which carry it through 
the tissues. The muscles of the venous walls are weak, 
and the flow in them depends somewhat on the repeated 
pressure of the body movements, though to much less degree 
than does that in the lymph vessels; valves occur at intervals, 
permitting a current in only the one direction. The pressure 
of chest movements could help pump the heart, but the latter 
has such a powerful muscle that it does not need this help. 

Among the maladaptments to the upright position which 
occur occasionally in human beings, is an abnormal weakness 
of the valves and walls of certain veins (varicose wins). 
These veins dilate from the pressure of their columns of blood. 
Such veins of the lower rectum ( hemorrhoids: piles) are more 
troublesome when the bowel is constipated; persons who are 
troubled even mildly with them should be careful to avoid 
constipation. A simple and effective surgical operation 
corrects hemorrhoids, and another corrects varicose veins 
of the scrotum {varicocele). Varicose veins about the legs are 
not so readily overcome; the wearing of supporting bandages 
or elastic stockings is in most cases preferable to operation. 


19G 


THE FOUNDATION OF HEALTH 


The use of circular garters might make worse such veins in 
the leg, and is to be avoided. The condition tends to get 
worse also if the person must stand for hours at a time. Else¬ 
where than in the three regions mentioned, varicose veins 
rarely become troublesome. 

Arteriosclerosis.— The commonest obstacles to heavy exer¬ 
cise are the defects to which heart and arteries are subject. 
One of them is the hardening and loss of elasticity of the 
arterial walls ( arteriosclerosis ). As age advances beyond 
middle life, some fibrous tissue tends to develop among the 
cells of the arterial walls and of the heart; sometimes a good 
deal of calcium is also deposited. The arteries become more 
or less rigid. A high blood-pressure from nephritis or any 
other cause stretches the vessels and hastens the hardening. 
Excessive use of rich foods, alcohol, and tobacco, or continued 
mental strain, are thought by many physicians to hasten it. 
The condition tends to develop anyway as age advances. 

The hardening of the vessels raises blood-pressure, and 
an additional rise due to exercise can easily rupture the hard¬ 
ened and non-elastic wall. If the artery which breaks is one 
about the brain, the hemorrhage is capable of severe damage 
by its pressure within the skull (apoplexy); partial unilateral 
paralysis results, and sometimes death. To be safe, the 
physical exercise of advancing age should be less and less 
strenuous. Games selected in youth ought to include some 
suited for continuance through life. Football and track 
work are suited only to the first half of life, and should be 
supplemented by other forms of recreation adapted to the 
second half. Golf need never be given up, so long as health 
continues, and is a much favored game from youth to old 
age. 

Defect of the Heart.— Defect of the valves of the heart 
lowers the capacity for physical exercise. At every beat 
some of the blood is forced back through any valve that 
leaks, and as the tissues demand that a full supply still go 
forward the pumping done must provide for both. The 
muscle of such a heart gradually enlarges and strengthens 
until eventually it does easily the increased work demanded 
of it. Then the defect of the heart is said to be compensated. 


PHYSICAL EXERCISE 


197 


The heart is using much of its natural reserve, however, and 
does not respond to excessive strains as well as would a 
normal heart. The person with a compensated defect should 
stop exercising at once whenever he begins to feel queer or 
short-winded. He should never enter an athletic contest 
from which he cannot conveniently drop out at any time. 
All exercises should preferably be under the direction of a 
physician. 

If the strain becomes greater than the muscle can stand, 
the compensation breaks ( decompensation ). The symptoms 
of a non-compensated defect are swelling, usually about the 
feet, a bluish or dusky tinge to the lips or face, marked short¬ 
ness of breath after comparatively little exertion, and tender¬ 
ness in the liver region, about the lower ribs. Persons who 
experience any of these symptoms would do well to have 
their hearts examined, even though unaware of heart trouble. 
Swimming frequently overtaxes a defective heart capacity, 
especially if competitive or if the muscle has been strained 
already by previous exercise. Death from drowning in 
cramps is usually due to the failure of a defective heart. In 
some cases of valvular heart trouble the compensation does 
not readily establish itself, and the greatest of care must be 
long continued. 

Nephritis.— Another function which puts limitations on 
exercise is that of the kidneys; nephritis, or inflammation 
of the kidneys, could be made much worse by strenuous 
exertion. Nephritis is suggested by swelling about the feet, 
and is definitely recognized by findings in the urine. Con¬ 
siderable danger lies in the high blood-pressure which accom¬ 
panies chronic forms. Exercise would further increase this 
pressure. It would also add to the salts and other body 
waste, which already are being poorly eliminated due to 
hindrance by the disease. 

In severe cases the physician keeps the patient at absolute 
rest, and devises all possible means to aid the elimination. 
The milder cases need not have as great care as this, but 
if neglected entirely have a marked tendency to pass into 
the more severe forms. 


198 


THE FOUNDATION OF HEALTH 


Elimination and Absorption.— Exercise does not affect 
absorptive or eliminative capacity in kidneys, lungs, or 
intestine, but all of these organs feel the effects in some way. 
The lungs respond immediately to exercise. The respiration 
becomes faster and deeper with the increase of muscular 
work, due to stimulation of the breathing center by the 
carbon dioxide produced. Increase of the amount of oxygen 
about the lungs is demanded. The deepening of respiration 
opens up the entire membrane to the air and tends to enlarge 
the chest expansion. Effects of this were discussed before. 
Pulmonary disease makes excessive exercise harmful because 
of strains thrown on the circulation and other functions 
rather than because the diseased lungs themselves are not 
equal to the emergency. 

The aid of exercise to the digestive tract is principally an 
increase in peristalsis. Intestinal tone improves, and the 
abdominal pressure becomes firmer. Appetite increases, and 
any tendency to dyspeptic symptoms brought about by 
inactivity subsides. The value of exercise as a combater of 
constipation has been mentioned. On the other hand, 
exhausting exercise retards intestinal action; the much 
fatigued person makes a better meal after a short rest. Other 
connections between digestive activity and exercise were 
shown in an earlier chapter. 

Heat Regulation.— The heat-regulating mechanism must 
increase the blood supply to the body surface to eliminate 
excesses of heat formed by muscular activity. The skin 
flushes and sweating becomes profuse. Sudden chilling at 
this time, by a cold plunge or otherwise, blanches the skin 
instead and tends to shock, though most normal people who 
try it are not adversely affected. To those with circulatory 
disorder the danger is much greater. Respiratory disease is 
sometimes thought to be induced, but this is rather doubtful; 
a few persons find that they have to be careful. 

In the course of any fever exercise is bad, for the fever 
indicates a disorder of the heat regulating mechanism with 
reduced capacity to meet added demands. Rest in bed is 
called for, or at least a minimum of exertion. The febrile 
condition involves also an unnatural activity of the tissue 


PHYSICAL EXERCISE 


199 


metabolism, to which exercise would only add. The policy 
of trying to work a fever out of the system by hard labor 
cannot be harmonized with physiologic needs. 

The Mind. —Educational and recreative attainments were 
among the four purposes assigned to exercise early in this 
chapter. Both of these concern the mental workings, and 
but little need be added to what was said in the chapter on 
mental hygiene. Mental processes arise primarily from sen¬ 
sory impulses and lead eventually to motor activity. Study 
of such character as to keep the mind in the abstract and 
away from the body’s activity is self-sufficient in trained per¬ 
sons, but for the average student it should be accompanied 
by other mental habits which connect more directly with an 
objective. Physical education balances tfye mind by develop¬ 
ing also some mental qualities other than reasoning. 

Alertness, self-confidence, etc., are bred by team play, for 
instance, much more than by what has been called a purely 
“word education.” The mind with a tendency to introspec¬ 
tion reaches for outside contacts instead. Team play is a 
widely acceptable form of mental discipline; a gang of toughs, 
unless mentally defective, welcomes the athletic training 
which makes it a team. This opens the way for a further 
educational advance at which they would at first have 
rebelled. 

Recreation.— Recreative exercises have already been 
described as those games which transfer the mental workings 
from a tired association channel to a fresh one. Gardening 
might constitute a recreative exercise for office men, but 
not for the truck farmer. The recreative element might 
well dominate the indoor worker’s choice of an exercise for 
his general health. Individual calisthenics, which hardly 
attract the mind from its routine, compare poorly with the 
more diverting recreation in which others also join. Other 
factors in his choice have been referred to; one will bear 
repetition. 

Functions of the indoor worker react best to outdoor 
exercise. Recreational value of the indoors is less for him 
than that of the outdoors, for his surroundings are less com¬ 
pletely changed. The muscles of the eye which have been 


200 


THE FOUNDATION OF HEALTH 


tired by near work are rested better by the long distance 
views of the open. The open air stimulates the heat regulat¬ 
ing function more than would the most skillful ventilation 
of the house. Outdoor odors are more pleasant and add 
to the zest for the game. The outside light is more natural, 
and contains those rays which stimulate growth of tissue in 
much greater abundance; the vision also benefits from the 
more natural light. The comparison might be extended to 
other functions. The open air is too often thought of simply 
as an ideal source of oxygen for the lungs; this is the least 
of its advantages. 


Reading.* 

General, Camp, Chapter I. 

Growth of the Neuro-muscular System, Tyler, Chapter V. 
Disorders of Posture, Terman, Chapter VII. 

Estimation of Posture, Bancroft, Chapter II. 

Physiology of the Circulation, Hough and Sedgwick, Chap¬ 
ter IX. 

Various Circulatory Disorders, Cabot, Chapter III. 

Public Recreation, Curtis, Chapter V. 


See bibliography for titles and publishers of books. 


CHAPTER XII. 


THE HAZARDS OF CHILDHOOD. 

The applied hygiene of one sphere in life differs from that 
of another in emphasizing a different group of health prob¬ 
lems. A person prepares for approaching hazards more intel¬ 
ligently if he realizes which of the possible obstacles he is 
most likely to encounter. Preceding chapters emphasized 
most largely the problems of the student, and combined with 
systematic hygiene an applied hygiene of student life. The 
student will continue to meet the same array of hazards 
when his school days are ended, but he enters a few fields 
also in which others stand out. 

Child Hygiene. —Children cannot look ahead and safeguard 
themselves, so child hygiene becomes a problem for the parent. 
Many of their ills and dangers are never recognized unless 
the parent knows what to look for. Danger signs are there, 
but they attract the guardian only if watchful, and the child 
not at all. Babies cannot express themselves, and older 
children tell only of sudden discomforts. They are not 
conscious of ills suffered from birth or gradually acquired, 
for without experience of the normal they accept any condi¬ 
tion as natural. 

The hazards are elusive, but cannot be neglected. Whether 
or not the little one is to remain in the world at all depends 
often on their control; early childhood suffers a far higher 
rate of preventable deaths than does any other age group. 
Besides, it is only during childhood that many of the maladies 
of later life can be anticipated by preventive measures. 
Much of the body’s subsequent development suffers from a 
few uncorrected defects, the defect of one organ stunting 
the growth of another. Physical defects impede the mind as 
well as the body. Defects of the mind itself, while not subject 


202 


THE FOUNDATION OF HEALTH 


to prevention or correction, can have many of their conse¬ 
quences averted. 

Hazards of the Baby. —Conspicuous destroyers in early 
babyhood are nutritional, gastro-intestinal, respiratory, and 
general infectious diseases. A few clear-cut warnings of their 
approach might be borne in mind. A rate of increase in 
weight which differs greatly from the average points to nutri¬ 
tional derangement; the birth weight should about double 
itself in six months and treble itself in something over a 
year, though on bottle-feeding the early gain is less rapid. 
The condition of the gastro-intestinal tract is indicated by 
the bowel discharges; looseness and excessive frequency of 
these, or for babies fed on cow’s milk a persistence in them 
of curds, suggests trouble. The common cold is a frequent 
forerunner of serious respiratory infections in infants. High 
fever with convulsions or vomiting commonly ushers in their 
general infectious diseases; slight fevers result from very mild 
disturbances and beyond calling for rest in bed are not 
necessarily significant. 

Summer Diarrhea .—Intestinal disorder causes the high 
infant mortality rate of the summer months. Temporary 
and slight diarrheas are common in the summer and need 
give little concern. Teething is not responsible for them, 
even if they do occur with about the same frequency as the 
eruption of new teeth. It is the mild attack that develops 
into the severe summer complaint, however, and no diarrhea 
which continues for days is to be taken lightly. This danger¬ 
ous type of diarrhea is traceable in part to bacterial con¬ 
tamination in the milk used for feedings, in part to the 
debilitating effect of the heat itself, and in part to the use of 
feedings rich in sugar or otherwise badly proportioned. The 
hygiene of babies in the summer should have emphasized 
the pasteurization of all milk of ordinary grades, the wearing 
of clothing light enough to let out body heat, and the proper 
proportioning of feedings. Overheating of the body is a real 
danger; chilling is one in the fall but not in midsummer. 

Infectious Diseases —With autumn the hazards change. 
Summer diarrhea is no longer likely to be contracted; res¬ 
piratory and contagious diseases are more likely. Minor 


THE HAZARDS OF CHILDHOOD 


203 


respiratory diseases and some of the more contagious ones 
become dangerous due to complicating infection with various 
pus germs. This secondary pus infection extends often to the 
middle ear as otitis media, and less often but more seriously 
to the lungs as bronchopneumonia. Due to this pneumonic 
complication, whooping-cough is very often fatal throughout 
the first year or so of life; the disease is less common but much 
more serious then than in later childhood. It is only because 
of possible complication that common colds are hazardous. 

The traditional prophylactic against minor respiratory 
diseases is the avoidance of chilling. Chilling undoubtedly 
retards recovery, and there is some evidence that it lowers 
the healthy person’s resistance to such diseases. Protection 
from it is by avoidance of extremes both of warmth and 
cold. The baby which is bundled up and kept hot is the 
more liable to chill whenever it is accidentally exposed. 
These prophylactics are of secondary importance, however. 

The baby’s real protection against colds, just as against 
other contagious diseases, is in being kept away from infected 
persons. Whoever helps care for or plays with a baby during 
the course of a cold exposes it to the cold, and to consequent 
complications. Those who will not take the trouble to 
quarantine the nursery against persons with colds need at 
least entertain no delusions that they are safeguarding the 
baby by shutting off some harmless draughts. Danger 
always arises from mingling in crowds during the cooler 
months, for in outsiders a cold could not often be detected 
and avoided. 

Contagion in Children.— Isolation from infected persons is 
much less feasible for school children than for babies. The 
child who is to associate with others at all can hardly avoid 
some contact with children who have colds. It is impracti¬ 
cable to isolate him very strictly even when he is suffering 
from a cold, though his associations with others should at 
this time be as slight as possible. 

For the more serious contagions isolation should be strict. 
The presence of a sore throat, or of any of the highly con¬ 
tagious diseases other than colds, should exclude a child 
from all playmates, from school, and from any public place. 


204 


THE FOUNDATION OF HEALTH 


The symptoms of a cold will bear watching, for some of the 
infectious diseases of childhood may at first appear to be 
nothing more. In order that strict isolation for this more 
dangerous class of diseases be instituted as early as possible, 
parents should all have some idea of the beginning signs. 

Diphtheria.— Diphtheria as a rule comes on with severe 
symptoms and is not then neglected. Atypical cases may 
begin with a sore throat and only mild general symptoms. 
The throat membrane is always reddened, but the charac¬ 
teristic patch of white film described in a previous chapter 
does not always appear. All sore throat cases are best iso¬ 
lated and seen by a physician, especially if diphtheria cases 
are known to be in the vicinity. The disease may also attack 
the laryngeal or nasal mucous membrane. Any hoarseness 
or croup, or nasal obstruction of an acute type, is suspicious 
unless otherwise explainable; it is particularly so if associated 
with general symptoms. 

Measles.— An attack of measles may attract attention by 
a pronounced fever and aching, accompanied by catarrhal 
symptoms, or it may resemble at first an ordinary nose and 
chest cold. There is always some fever and usually redness 
about the eyes, with an aversion in the child to facing the 
light. Symptoms gradually become worse, and in a couple 
of days the membranes within the cheeks show small red¬ 
dened areolae about whitish spots (Koplik spots), which are 
characteristic of measles. In about two days more there 
appears about the face and neck a rash of scattered red 
spots, roughly circular and about 1-inch across. The spots 
increase in extent and number and tend to coalesce; eventually 
the body may be practically covered with a blotchy eruption. 

German measles does not have symptoms enough for 
recognition until the rash appears on the skin, and after this 
the condition is unlikely to be neglected as the rash is 
usually quite intense. 

Whooping-cough. — Whooping-cough seems at first to be 
nothing more than a simple cold. A cough develops, which 
after a time becomes spasmodic. The child will then give a 
series of hard coughs without taking breath, inhaling finally 
with a long and noisy whoop. The spasmodic stage develops 


THE HAZARDS OF CHILDHOOD 


205 


most commonly in about ten days, but sometimes only after 
a much longer period, or not at all. An earlier diagnosis is 
often possible to the physician, who by laboratory test can 
often diagnose as whooping-cough a case with only the symp¬ 
toms of a chest cold. 

Mumps.—Mumps begins as pain or tenderness followed 
by gradual swelling beneath the lobe of one ear. For a few 
days the swelling continues to enlarge and causes pain on 
chewing; there is some accompanying fever. The other side, 
when involved, begins to swell a few days after the first. 
The condition is not likely to be overlooked by one who has 
in mind the possibility of mumps, though it may be confused 
with swellings from pus infection. Mumps may also occur 
beneath the lower jaw, in which position it is frequently con¬ 
fused with pus infection of the lymphatic glands there. 

Smallpox and Chicken-pox.—In chicken-pox, the rash is 
preceded by no other symptoms, or at most by a slight fever¬ 
ishness for a day. Small reddened elevations, or papules, 
develop in the skin, usually over the face or trunk first. 
These change in about a day into small blisters, or vesicles, 
which can easily be rubbed off to leave a smooth red surface; 
meantime new ones keep appearing. 

Smallpox differs from chicken-pox in the severity of general 
symptoms and certain differences in the rash, though in 
atypical cases the distinction may be difficult. The onset of 
smallpox is usually with severe aching, high fever, and vomit¬ 
ing or convulsions, all of which precede the rash by a few 
days. The lesions in the skin are deep instead of superficial 
as in chicken-pox, and would not leave a smooth surface 
if the vesicles were rubbed off. The change of papule to 
vesicle takes two days, as does then the change of vesicle to 
pustule, a much slower cycle than that of chicken-pox. 

Scarlet Fever. —Scarlet fever in children nearly always 
begins with a rapid rise in temperature to 104° or 105° F., 
accompanied by vomiting and sometimes convulsions. The 
throat is somewhat sore and its membrane uniformly red¬ 
dened. The next day a diffuse rash appears over the chest 
and neck, which if closely examined is found to be made up 
of tiny red points. Within a day, or often within a few hours, 


206 


THE FOUNDATION OF HEALTH 


the rash spreads over nearly the entire body. The very 
exceptional case may begin with a mild irritation of the 
throat and but slight fever, to be followed by comparatively 
little rash. 

Comparative Mortality of Infectious Diseases. —Of these 
infectious diseases, three need hardly be feared; chicken-pox, 
mumps, and German measles do not endanger life. Neither 
does whooping-cough after infancy is passed. Among chil¬ 
dren who are immunized, as they should be, smallpox and 
diphtheria are not menaces. 

The heaviest toll in lives is taken by diphtheria, due to a 
common failure of parents to obtain early enough medical 
attention. The mortality from scarlet fever, measles or 
whooping-cough is in some years higher for scarlet fever and 
in others about the same for the three. Measles and whoop¬ 
ing-cough have a much lower percentage of fatalities among 
those sick, but they occur much more widely. The tradition 
that these two are relatively negligible persists from over 
half a century ago when scarlet fever and diphtheria killed 
almost four times as many children as measles and whooping- 
cough. The perilous practice of deliberately exposing chil¬ 
dren to them is fortunately being abandoned. 

Specific Immunization.— Two of the contagious scourges 
can be controlled through inoculations which raise a specific 
immunity, and all children should be given these inoculations 
in time to antedate exposure. The first vaccination against 
smallpox is done preferably during early infancy, as the 
reaction to the vaccine is not then severe and susceptibility 
to smallpox begins in infancy. 

Active immunization against diphtheria requires several 
months, and non-immune children should be inoculated in 
very early childhood. The greatest danger of diphtheria is 
when the young child begins to mingle with others. Those 
do not require immunization who are shown by a skin test 
(.Schick test ) to be immune naturally, though the immunity 
indicated might not persist throughout childhood. 

Active immunization against whooping-cough has been 
widely attempted, but the results leave considerable doubt 
as to its efficacy. Encouraging results have attended an 


THE HAZARDS OF CHILDHOOD 


207 


inoculation of the serum of convalescents from scarlet fever 
and from measles to children who have been exposed to 
those diseases, though the procedure is still in the experi¬ 
mental stage. The other diseases of the group have as yet 
no specific preventives. 

Avoidance of Exposure.— The fact that scarlet fever and 
diphtheria are so often milk-borne recalls again the matter 
of pasteurization. An additional preventive of contagion 
among children consists in their observance of certain 
hygienic habits. The child should be taught that whatever 
practices pass from another child any traces of mouth secre¬ 
tion are dangerous. He should be discouraged from biting 
off of the same ice cream cone or apple, from chewing the 
same pencil, and from mouthing the same toys as a play¬ 
mate. The smoothly finished, so-called sanitary toys visit 
children’s mouths more often than do fuzzy toys, and might 
presumably transmit more contagion. A child who has signs 
of a cold or other communicable disease should not play with 
other children at all, and the others should avoid him. 

This sanitary regime calls for a complete reformation of 
childhood’s habits, but the accomplishment of such a reforma¬ 
tion is not hopeless. Our small children are taught dictates 
of decency which are unheard of among other civilized 
peoples and which they accept only when persistently dwelt 
on; they could quite as easily be taught the more important 
practices which prevent contagion. A rigid avoidance of 
others’ mouth secretions would seem strange to most of 
them to-day, but this is because they are not taught. 

Teachers of hygienic habits among children accomplish 
something by the health story, and more by continued insist¬ 
ence. Talks and stories attract the child’s interest and link 
up health with the hygienic practices. It is then easier to 
insist on the practices. Health stories fit naturally into 
childhood. One which caught childish imagination many 
years ago was about little woolly caterpillars, or “fever 
worms,” which according to old negro story tellers gave “the 
fever” to all who saw them; fortunately, the victims might 
save themselves if they would spit and touch wood. Children 
did spit and touch wood when they saw such caterpillars. 


208 


THE FOUNDATION OF HEALTH 


The modern story, with its sound foundation, can equally 
be relied on as a guide for habits. 

Tuberculosis.— Hazards continue to change with the child’s 
advancing years. The contagions of childhood are gradually 
replaced, as most fatal of diseases, by tuberculosis. Tuber¬ 
culosis presses forward to fourth, then to third, and toward 
the end of childhood to first rank, and from here it never 
recedes far. 

The anti-tuberculosis fight in children cannot contemplate 
a total avoidance of the germs. All persons become exposed, 
and practically all develop small lesions of tuberculosis, 
though in most cases the tissues wall off or destroy the invader 
and allow it to do no harm. Safety is in proportion to the 
tissues’ resistance. When a child’s resistance loses all hold, 
the infection floods the system and terminates fatally, usually 
with symptoms of tuberculous meningitis. This occurrence 
is not common because the average resistance does hold the 
disease in check throughout childhood, even in cases which 
are to succumb later in life. The hygienic aim is to prevent 
such massive infection as the body might at the time be 
unable to withstand, and by proper nourishment, outdoor 
play, and avoidance of fatigue to build up the resistance. 

Massive infection with tubercle bacilli can result from 
associations with a mother who has active tuberculosis. 
Such a mother not only endangers the baby w T hen she insists 
on caring for it, but makes her own condition worse by the 
tax on her strength. The baby’s tissues are not resistant 
and quickly give way to such heavy doses of infection; in 
the course of time, perhaps after many years, this infection 
in them will make itself felt. Another source of massive 
infection, though not with the most dangerous type of 
tubercle bacilli, is the milk from tuberculous herds of cattle. 
Dangers from contaminated milk crop up at many places 
in child hygiene, and the importance of pasteurization applies 
most strongly to this period of life. Babies and children 
should not use raw milk of the ordinary market grade, nor ice 
cream or other products made without heating from such milk. 

Malnutrition. -Poor nutrition of the child’s body signifies a 
doubtful resistance to tuberculosis. Malnutrition favors the 


THE HAZARDS OF CHILDHOOD 


209 


encroachment of tuberculous infection and such an infection, 
by reducing the tissues’ ability to utilize foods, can aggravate 
the malnutrition. Malnutrition is indicated by a pallor 
of the skin and a sinking in between the ribs, or by a weight 
which falls 10 per cent or more below that averaged by 
children of corresponding age. 

An average increase in weight runs somewhat as follows: 
The weight at one year is almost triple the birth weight, and 
that at two years 6 pounds more, or in the neighborhood of 
26 pounds; after this the yearly increase averages 4§ pounds 
up to eight years, and 6 pounds during the few years follow¬ 
ing. This is only a rough statement of averages, from which 
there is variation due to sex, race, and other influences on 
the stature; a wide and unaccounted for deviation from it is 
suggestive enough, however, to recommend a physician’s 
examination. About one-fifth of all American children are 
malnourished. 

Predisposition to tuberculosis is but one of the hazards 
associated with malnutrition. Malnourished children cannot 
concentrate as long or learn as much as they could with 
normal nutrition. Their general musculature is weakened, 
predisposing to postural defect. Bad posture is encountered 
among children about as often as underweight, and to a 
considerable extent in the same children. Adenoids or other 
physical defects are more common in poorly than well- 
nourished children. Such children become referred to as 
“delicate.” 

In the managment of malnutrition, three things are to be 
sought, the best possible feeding, plenty of outdoor life, and 
an avoidance of any fatigue. The diet has the general 
features of the normal diet previously pointed out, though 
the caloric values are not held down to the averages there 
stated. The three full meals a day may be supplemented by 
a mid-morning or mid-afternoon glass of milk with graham 
crackers, but not by irregular eating between meals which 
would spoil the appetite. The drinking of a quart of milk 
daily is strongly advisable for underweights. When the 
weather permits comfortable outdoor sleep, the sleeping 
porch is of service in their management. Day dreaming and 
14 


210 


THE FOUNDATION OF HEALTH 


the reading of story books should give place to outdoor play, 
though in these children play should not be carried to the 
point of fatigue. A disposition to irritable and tearful moods 
often means that the child is being tired too much, by its 
play or otherwise. 

Too much schooling is a source of fatigue for them, and it 
is better that they begin school too late than too early. Study 
during the vacation period is unwise. In the lower grades, 
the young mind does its full day’s work in the school, and 
any outside school work or extra lessons in painting, music, 
etc., is to be discouraged. Brilliance of the child’s mental 
accomplishments gratifies parents, but an apparent brilliance 
should not be bought at the cost of overwork. The mind is 
the master of the other functions, but it should not enrich 
itself at their expense. Overwork does more hurt to girls than 
boys, chiefly perhaps because girls are conscientious enough 
to do what is expected of them, where boys evade. 

An ordinary school day proves fatiguing to the consider¬ 
ably undernourished, and is best replaced by a special routine 
in open-air classes. The routine should provide for the child’s 
nutrition, for an outdoor day, and for the avoidance of fatigue. 
In some cities the children of such classes are all furnished 
with substantial meals at the school. A location beneath 
sheds on the roof, or in a room which can have one side 
entirely opened up, affords plenty of fresh air; in cold weather 
the children are made comfortable by warm wrappings 
rather than by the heating of the room. 

The school work is shortened into relatively brief morning 
and afternoon sessions, between which intervenes the dinner 
and a long rest on cots. The rested minds do more and better 
work, in these short sessions, than the tired minds by plodding 
through a full school day. The malnourished child gains 
less from much work when fatigued than from little work 
when rested. 

Physical Defects.—Defects other than nutritional also 
handicap the child in physique and in mind. The child who 
cannot hear all that the teacher says, or whose eyes tire 
before the lesson is read, naturally falls behind in its work. 
Neither the child nor anyone else knows why it fails until 


THE HAZARDS OF CHILDHOOD 


211 


the physical defect is looked for. Examinations of entire 
groups of school children always reveal many defects, and for 
the most part they are defects which had been unsuspected. 

Defect of the teeth is the rule. Malnutrition, defective 
vision, and obstruction in the upper respiratory tract each 
claim over one-tenth of all children; proportions smaller 
than this have defective hearing, infections of the ear, or 
glandular swellings. Mental defects also occur in a small 
proportion of the children. 

Sometimes there is encountered a most unfair reluctance 
on the part of parents to have their children’s defects looked 
after. Some parents feel that surgery ought not to interfere 
with what nature has done, but it is only the hindrance to 
nature’s workings with which surgery cares to interfere. 
Others, unable to pay for surgical procedure, have a queer 
sort of pride that is hurt more at the thought of sending the 
child to a free clinic than at the thought of stealing away its 
chance for health. Children with mental handicaps are 
withheld from a training specifically adapted to them, 
because parents wish that the child could get along without 
it. Realization of the full consequence of handicapped 
development would soon clear away any hesitancy to have 
the hindrances taken care of. 

Examination for Faults.—A physical examination is the 
due of every child, for many curable defects could not other¬ 
wise be known. The children most obviously needing exami¬ 
nation are those who appear in some way unusual. The child 
who is backward in school work, or is unruly, “nervous,” 
or indifferent to the ordinary interests of childhood, is a 
child with symptoms of disorder. The one who sleeps with 
the mouth open, who tires easily, or who has any evident 
difficulty in sight or hearing, is another. The physical 
examination of these unusual cases will in most cases reveal 
something wrong. 

If physical defects are not found, a psychiatrist might 
examine the mind for some deviation; no child should be 
assumed to be “mentally queer” without this being done. 
Sometimes he would find cause to recommend special educa¬ 
tive methods. A child that is mentally defective cannot be 


212 


THE FOUNDATION OF HEALTH 


expected to make its own way in the world, as can other 
children. Probably one-half of the criminals are such 
because of a mind which could not develop as do average 
minds. What the trait is that makes the child unusual should 
in any case be determined. 

Play.— Normal children do not need the sort of care advised 
for underweights, any more than they need the correctional 
measures for any other defect. Unlike the delicate ones, 
they can play until dead tired, and then sleep so much the 
better and wake up,quite fresh. Plenty of outdoor play 
means for the healthy child a good appetite and proper rest, 
assuming that bedtime is early enough to permit a full quota 
of sleep. 

Enthusiasm for play is the great building force of the 
child’s body. It springs spontaneously from an inherent 
developmental urge, and it serves to activate inherited powers 
of the body. Girls are driven instinctively to mother dolls, 
boys to hunt, and both to deal in their play with others; 
they unconsciously prepare for activities which the race has 
found profitable. 

Play-grounds.— Communities are beginning to realize 
that since the child develops through play it must have a 
play-ground. In the congested parts of cities nothing more 
than a small plav-ground is possible, and it is only with 
apparatus that active play can occupy all who congregate. 
The need for apparatus is inversely proportional to the area 
of ground available. Where the ground is sufficient for all 
the children to run about and play games, apparatus can 
be dispensed with. Play-ground directors attend the best 
ordered grounds to supervise games; they also see that the 
children use the apparatus properly and not for dare-devil 
stunts, and that the stronger children do not monopolize 
the apparatus. 

Dementia Precox.— One of the bad influences which help 
to bring about adolescent insanity (dementia precox) is the 
abnormal restraint under which children of congested dis¬ 
tricts must grow. When there is no opportunity for the 
child to play, and the normal instincts cannot assert them¬ 
selves, mental disorder tends more to develop. The occur- 


THE HAZARDS, OF CHILDHOOD 


213 


rence of the disease is infrequent in rural and suburban 
districts where natural play-ground abounds. Fortunately, 
the danger extends only to those of a certain hereditary 
make-up. Inherited traits play a greater part perhaps in 
some types than others. The earliest symptoms of dementia 
precox appear as an extreme form of the silliness and 
dreaminess that often accompany adolescence; the patient 
becomes moody as time goes on, and signs appear of some 
form of insanity. 

Street Accidents.— Street accident is another peril of middle 
and late childhood traceable to the absence of ground for 
play. The street is the only play-ground that many children 
have, and at the hours when they use it as such automobile 
accidents reach their greatest frequency. As boys play in 
the street more than girls, they are the commoner victims. 
In the sense that any driving in a play-ground is reckless, 
reckless driving is at fault; but often there is no other place 
to drive or to play. To correct the condition, other grounds 
must be found for children to play. Meantime, the only 
move is to teach children to be watchful. 

Direction of Play.— The only essentials to play are the 
unspoiled natural instincts, some playmates, and a play¬ 
ground, but the advantages are greater if we add to these 
organization and the direction of an expert. Children’s 
play is imitative and seeks guidance; the boy does circus 
stunts after a circus has passed, and he plays games as he 
sees them played. The play which follows these haphazard 
inclinations does not bring the returns in health that the 
play guided by a director would. 

The director’s planning must accord with the natural en¬ 
thusiasms of the child, of course; accepting the urge of boys 
to compete, he merely plans the nature of the competition. 
His plan for choosing sides often adds to the competition, 
as natural groupings would put the stronger into one side. 
Other interests are similarly made use of; group dancing 
appeals more to the average girl than would a competitive 
exercise. Organized play disciplines in that rules are fol¬ 
lowed, and the character of the rules laid down determines 
the physical exercise done. 


214 


THE FOUNDATION OF HEALTH 


Summer Camping. -Direction of play is perhaps the greatest 
health building factor about the summer camps for children, 
though a less conspicuous one than the use of a great and 
diversified play-ground. The measure of health which the 
child brings home from the outing is the product of a direc¬ 
tor’s planning. The aloof child who did not swim or play 
ball has been taught to do so, and been thereby drawn into 
the crowd. If he and others like him had been allowed to lie 
around and get homesick the camp morale would have 
slumped; success of the camp depends on the keeping up 
of a general spirit of doing. The personnel of the directing 
staff is the first item in the selection of a summer camp. 

Camping of children in large groups has attendant dangers 
which are overcome only by strict medical and sanitary 
supervision; this is the second item in the selection of a 
summer camp for the child. If a physician is not in attend¬ 
ance, there should at least be a nurse on the ground and the 
services of a physician within calling distance. To provide 
for the occasional invasion of the camp by contagious dis¬ 
ease, the hospital room or tent should be adapted to isola¬ 
tion. By a preliminary inspection of the children to be 
admitted, the bringing in of transmissible disease is largely 
prevented. The summer season in itself is a safeguard; 
epidemics of diphtheria, scarlet fever, measles, whooping- 
cough, smallpox or meningitis are usually in the colder 
months. Vaccination of the campers removes all danger of 
smallpox. 

Sanitary provisions include such disposal of body dis¬ 
charges that there is no exposure to flies, nor drainage toward 
water supplies. Until the safety of a camp’s drinking water 
has been assured by laboratory test, the water is best boiled. 
Ventilation needs attention, even in camps; that in a tent 
with its flaps down or in a room full of cots is often decidedly 
poor. 

Swimming Pools and Beaches.—The swimming hole also 
harbors a few dangers to the child. The natatoria or beaches 
in the city are usually more of a problem than are the streams 
and pools in the country. The water transmits microbes, 
not only from any polluting sewage or ship waste, but also 


THE HAZARDS OF CHILDHOOD 


215 


from intestinal or pus lesions of bathers. Typhoid fever 
germs from a carrier or pus germs from a discharging ear 
infection or boil, could easily infect people in the water. 
This danger increases with the crowding of the beach or 
pool, and with the absence of current to keep changing the 
water. Chlorination of the water where feasible reduces 
this danger to a minimum; a 12-ounce box of bleaching 
powder per each 30,000 gallons of water is used daily. 

Regulations should exclude all persons known to have any 
sort of open infection or to be carriers of any disease; others 
should provide that all bathers take a bath with soap before 
entering the water. Drowning is guarded against if the 
water be kept clean and transparent in natatoria, or if there 
are life ropes at the beach; life guards should be on hand at 
either. 

Drowning.—In number of victims, drowning ranks high 
among the fatal accidents of late childhood. It is an accident 
more peculiarly of occupation, as the greatest incidence is 
among those whose pursuits bring them about the water. 
Among children, the coupling of an inability to swim with a 
love for the water is chiefly at fault. Children who live or 
visit near a body of water should all learn to swim, and until 
they can do so should go in the water only with responsible 
elders. It is best to learn in early childhood, though the 
attraction to the water and the drowning hazard are greater 
as age advances. An examination of the heart of all young 
swimmers should be made to safeguard them from cramps. 

Bums.—The ranking fatal accident caused by the play of 
very small children is that due to fire. Fire looks very invit¬ 
ing to those in the first few years of life, who are making the 
acquaintance of all the new things they meet. One popular 
preventive is to burn the child’s fingers and thus satisfy its 
curiosity, but this injures the child; it has no justification 
except that it does work. Fire of its clothes is extinguished 
most quickly by wrapping in a blanket; it is a good plan to 
have blankets handy at all times, even in the summer. As 
later childhood is reached, the risk of death from burns and 
conflagrations drops. Only under constant surveillance is 
the young child safe from accidents. 


216 


THE FOUNDATION OF HEALTH 


Accidents of childhood are more carefully guarded against, 
on the whole, than the general diseases, and therefore are 
not nearly such a menace. All accidents combined kill but a 
slightly greater proportion of our children than does tuber¬ 
culosis alone. 


Reading. * 

General, Rapeer, Chapter IV. 

Influences on the Child's Growth, Terman, Chapter IV. 
Infant Mortality and its Problems, Brend, Chapter III. 
Management of the Young Child, Scurfield, Chapter VIII. 
Mental and Moral Training of Children, H. D. Chapin, 
Chapter IV. 

Postural Development and Play, Cromie, Chapter III. 
Places for the City Child to Play, Curtis, Chapter VI. 


* See bibliography for titles and publishers of books. 


CHAPTER XIII. 


HEALTH IN THE HOME. 

Domestic Hygiene.— Domestic hygiene is that applied to 
the selection and management of a home. Housing condi¬ 
tions influence very notably the health of children and to a 
less degree that of older persons. Incidence and death-rate 
of tuberculosis and of contagious diseases, for instance, is 
lowered in proportion to enlargement of the living quarters. 
Housing conditions other than crowding also interfere with 
health. Bad ventilation of houses, or an infestation with 
vermin, leave their mark on the health of children by pre¬ 
venting normal sleep. Many more examples might be cited. 

The individual’s control of the situation has unfortunate 
limitations. Economic and social conditions compel people 
to live where they can afford to and largely as their associates 
do, rather than in any forests or mansions which they might 
perhaps prefer. Much can be done by anyone, however, 
to improve the sanitation of his own household. 

Detached Homes.— The general drift of city people toward 
apartment life has its influence on their health. The flat 
partially solves the housekeeping problem as it is kept in 
order with less work, but this does not entirely overshadow 
the many advantages of the detached home. The latter 
has lighting and natural ventilation on four sides, and it 
affords a ground for the children to play. It permits a home 
life of privacy, more to be desired even than the fascinating 
pastime of piecing together the affairs of neighboring flat 
dwellers. The fire risk is lower, for carelessness by any of 
several families might burn the apartment. Multitudinous 
noises, the smells of cooking, and migrations of bugs and 
mice, all characteristic nuisances in the flat, can be excluded 
from the detached house. On the whole, hygienic considera¬ 
tions favor the house. 


218 


THE FOUNDATION OF HEALTH 


Location of the Home. —Local determinants of a healthful 
residential location are too varied for enumeration. The 
nearby presence of dirty railroads, noisy factories, and 
garbage dumps, though not demonstrably hurtful, is dis¬ 
agreeable. Congested neighborhoods are bad. The most 
healthful location is generally as far distant from the city’s 
congested center as vocation and commuting facilities per¬ 
mit. Rural residence is commended by the outdoor recrea¬ 
tion and other advantages which it affords. For those of the 
family who are not brought regularly to the city for their 
work or schooling, it exposes less to communicable disease. 
Given the same amount of health supervision, it has a lower 
rate of sickness and early death than has residence in the 
city. The suburbs hold the same advantages, in less degree, 
over the in-town residence sections. 

The damp locality near a body of water is not necessarily 
unsanitary for residence, if it is breezy and comfortable. 
The lot should be high enough for the rapid drainage of 
waters from it, especially if children are to play there. Exces¬ 
sive moisture in the air affects health rather less than it does 
the house furnishings; musty and moldy odors, discolorations 
on the walls, and mildew on shoes and clothes result from 
too great humidity, as does also the rotting of woodwork and 
rusting or corrosion of metals. 

The mosquito seeks moisture, and in zones of mosquito- 
borne disease the moist locality might be avoided for this 
reason; there also are chronic illnesses which physicians find 
to be aggravated by an excessively humid atmosphere. 
Humidity would not often affect health, if the temperature 
and air currents can be controlled to compensate. More 
attention would have to be paid to heating and ventilation, 
for high humidity renders half-heated houses inordinately 
chilly, and those without good circulation of the air inordi¬ 
nately close. 

Heating of the Home.— Householders rarely decide without 
expert advice on a general heating system for the place, but 
those who are to employ the smaller heating devices need 
to know their respective hygienic merits. There is the fire¬ 
place, the stove, the electric heater, the gas heater, and the 
oil stove. 


HEALTH IN THE HOME 


219 


Fireplaces and stoves are the most economical in average 
localities, where coal and wood are relatively cheap. The 
advantage of the fireplace over the stove is that it draws air 
up the chimney and thus brings fresh air into the room by 
suction, that it seems more cheerful, and that it throws 
into the room a minimum of dust and combustion gases. 
The stove stirs the air of the room but does not bring in so 
much from the outside, and it is dustier than the fireplace. 
The stove is the warmer of the two because it loses less of its 
heat up the chimney and warms the room by convection as 
well as radiation; the radiant heat from the fireplace tends 
more to warm the face and leave the back chilled. Both 
are rather bothersome. 

Electricity heats well, through the agency of resistance 
coils and reflectors, and is clean and easily operated; the 
expense is great though, and limits its use under average 
conditions to supplementary heating. The oil stove serves 
similarly as a portable heating unit; it is inexpensive but 
smelly. 

Gas Heaters .—The gas heater is rather more likely than 
the other devices to imperil the residents’ health, because of 
the emission of fumes. Except for fumes of unburned gas, 
the gas heater is not unhygienic. It is clean, promotes a 
desirable circulation of air, and requires no work. The degree 
of heat is readily controlled. It is the cheapest means of 
heating in localities about oil regions where natural gas 
occurs; natural gas is a relatively harmless mixture of 
which the chief constituent is the combustible methane, or 
marsh gas. 

Artificial gas has a certain percentage of carbon monoxide 
which renders it more poisonous than natural gas. Bathroom 
water heaters burning gas have proved to be particularly 
dangerous, unless connected with a flue, because so many 
bathrooms are poorly ventilated and the cold metal of the 
heater at first chills the fllame and hinders combustion. Prod¬ 
ucts of a complete combustion of gas are not injurious, and 
the need for flues depends on the emission of unburned gases. 
Opinion is divided as to whether several other types of gas 
heaters ought not also to be equipped with flues. 


220 


THE FOUNDATION OF HEALTH 


Gas Poisoning.— Poisoning with carbon monoxide is usually 
a domestic accident, babies and small children being the 
commonest victims. Artificial gas is nearly always at fault, 
though coal and wood fires also emit fumes of carbon mon¬ 
oxide when not drawing properly. The same fume occurs 
in the exhaust from automobiles, and the running of engines 
in garages has often led to fatal poisoning. 

Neglect or carelessness with illuminating gas is the principal 
danger. The gas is turned low and later blows out. The 
stopcock shutting off the flow is turned too far and lets it on 
again; or the cock at a droplight is turned off instead of that 
at the fixture, permitting the escape of gas through a leaky 
rubber tube. Combustion is interfered with by flaring, by 
filthiness of the burner, or in some types of burners by the 
burning of gas before air is properly mixed in—‘‘striking 
back.” Poisoning by gas is to be avoided by close attention 
to fixtures, keeping small children away from fixtures, and 
due regard for ventilation. 

Ventilation of the Home.— The ventilating system in homes, 
together with the heating plant, is designed to facilitate 
comfortable elimination of body heat, as explained before. 
It contemplates also an improvement in the air’s material 
contents. The air of the house is to be freed from offensive 
fumes, odors and dust. Through processes of natural ventil¬ 
ation, fresh air is brought from the outside to replace the air 
which contains any gas fumes, offensive odors, smoke, dust, 
or excessive moisture. The kitchen and bathroom in par¬ 
ticular should ventilate to the outside and not into the rest 
of the house, for their air is most heavily charged with these 
nuisances. Slight odors arise from organic substances given 
off from the skin and mouths of persons in the room. Rather 
strong odors are emitted from the decay of mouth or throat 
infections, and in the case of unclean people from decaying 
matter and body waste in the sweat. Unless there is pro¬ 
vided an hourly allowance of fresh air proportional with the 
number of individuals who occupy it, any room becomes close 
and unpleasantly odorous. 

The rate of renewal of the air from the outside should not 
be great enough to cause uncomfortable draughtiness; such 


HEALTH IN THE HOME 


221 


draughtiness would result from living rooms having more than 
three changes of their air content per hour. A greater rate 
of change than this is permissible in bedrooms, where draughts 
are not so unpleasant. Three thousand cubic feet of air per 
person per hour has been recommended by authorities on 
the subject; where the ventilation is to afford only three 
changes hourly, this provision requires 1000 cubic feet of 
space per person ordinarily occupying. Bedrooms may be 
smaller if the occupants are comfortable in a draught. 

It is not only by draughtiness that the bringing in of out¬ 
side air can produce discomfort. On a hot summer day the 
inside air is cooled more through the midday hours by closing 
the house and turning on the electric fan than by opening 
up all the windows, and unless odors or fumes result this 
enclosed air is less objectionable than hot and uncomfortable 
air brought from the outdoors. 

Dust and Dirt.— A large provision of air per person pro¬ 
motes health also by diluting any germs of contagion con¬ 
taminating the mouth-spray coughed out or dust stirred up 
by those present. Dustiness is not a conspicuous hazard to 
health, but under some conditions it does predispose to 
respiratory, eye and skin infections. The dust problem is one 
less of ventilation than of house-cleaning. Dust should not 
noticeably fill the air, nor enough collect on furniture to soil 
the hands and clothes. Cleanliness has its greatest hygienic 
bearing in the nursery and playroom where children play 
on the floor, and in the kitchen where foods could be con¬ 
taminated. 

In general, a hygienic degree of cleanliness need not equal 
the spotlessness of refined housewives’ ideals. The buildings 
in which the men and school children spend their working 
hours are by no means prim and immaculate, but they do 
not conduce to ill health. Sanitation of homes, as of other 
buildings, is exacting but not overexacting as to cleanliness. 

Housekeepers’ Fatigue.— The fatigue from cleaning and 
other housekeeping activities is itself an added hazard to 
those in imperfect health, as for instance any affected mildly 
with nephritis or tuberculosis. A fatigue which dominates 
the day’s activity might engender in well housewives a 


222 


THE FOUNDATION OF HEALTH 


feeling of discontent, and a generally unhealthful mental 
state. Not only does the housewife face enough work to 
tire her out, but she is caught by the dread of endless duties 
lying ahead. The drag is not so heavy if she can look forward 
to recreation at the end of the day’s routine, and the routine 
ought to be so planned as to permit this. 

Fatigue and aversion to the work arise too from poor 
adaptation to housekeeping, due to bad training. Young 
women often train themselves for office work, in spite of an 
aim eventually to become housewives; on acquiring homes 
they are strained by the unskillful attempt at caring for 
them. Schools have attempted to overcome this difficulty 
by teaching cooking, the care of babies, sewing, etc., but 
such training can be only superficial. Domestic science 
courses bring science into the management of the home, but 
they do not provide the drill which will mean housekeeping 
ease and efficiency. 

Housework by the Children .—Helping about the house 
therefore contributes to the welfare of older girls, if they are 
in good health. Fewer and fewer can look forward to being 
housewives without such \york to do; incidental to our immi¬ 
gration policies it is becoming more difficult each year for 
the average family to depend on servant labor. Immigrat¬ 
ing servant classes remain such only until American senti¬ 
ment has inspired preference for work among equals, which 
takes about one generation. Negro servants have become 
fewer and less dependable than in former years and this ten¬ 
dency also is likely to continue. 

Work about the house at the expense of their health should 
not be demanded of children. It would quickly tire the 
malnourished child and retard recovery. All of the younger 
children need as much play as their energies will stand, and 
housework in addition is too great a task. Unfortunately, 
it is also too great a task for the mothers in many homes. 

Sanitary Cleanliness in the Home.— The home can be so 
planned as to cut down somewhat the work required for its 
cleaning. The scattering of small pictures over the walls or 
the use of intricately ornamented furniture adds little to the 
attractiveness of the place and much to the tedium of dusting 


HEALTH IN THE HOME 


223 


it. Hardwood or varnished floors are the easy ones to clean, 
or the kitchen floor covering of linoleum. 

By sanitary cleanliness is meant simply the mechanical 
removal of dirt and odors. Fresh air and sunshine after the 
usual sweeping or scrubbing accomplishes more than the 
use of odoriferous antiseptics. The sprinkling around of 
antiseptic solution does little but raise a bad odor anyway; 
the solution must actually soak an object to sterilize it. 
Such solutions are of value only where undesirable living 
forms can be soaked and destroyed. A valuable one for 
this purpose is compound cresol solution, used in 1 per cent 
strength; it is highly germicidal and has but a mild odor. 

The Antiseptic Fad— The designation of ordinary house¬ 
hold materials as “ antiseptic” is principally a selling feature 
based on the popular regard for the term. Even shaving 
creams have been advertised as antiseptic. As cleansers 
for the teeth, tooth pastes are preferable to baking soda 
because they taste better, but the more advertised feature of 
pastes is the antiseptic quality. 

So-called antiseptic or germicidal toilet soaps remove no 
more of the bacteria from the hands than do the less preten¬ 
tious and cheaper soaps; some have inferior cleansing power 
and therefore remove fewer. Only the occasional person who 
carries disease need even think of removing germs when he 
washes his hands. Unless typhoid fever carriers wash their 
hands thoroughly after using the toilet they unconsciously 
pass the germs to others by their hands; for them an anti¬ 
septic need not be insisted on, and if used should come after 
washing rather than in the soap. 

Spread of Contamination.— Occasional associates are pro¬ 
tected only by the strictest of precautions on the part of a 
typhoid carrier; the closer associates should be immunized 
rather than take the chance. Carriers should have their 
individual soap and towels, and avoid so far as is possible 
the use of any article in common with others. They should 
in all respects keep scrupulously clean. The carrier condition 
is not quickly gotten rid of, even under treatment; the germs 
sometimes continue to be carried for as long as ten or twenty 
years, though this is exceptional. The carrier should avoid 


224 


THE FOUNDATION OF HEALTH 


even the passing of foods to guests at the table and keep out 
of the kitchen altogether. One of the common sources of 
small typhoid fever outbreaks is the carrier in the kitchen; 
outbreaks in one family after another have followed the 
wanderings of a carrier employed in turn by them as cook. 

Precaution against other infections is similar, though 
exclusion from the kitchen is necessary only for the intestinal 
group. Use of towels and such articles in common with 
others might easily disseminate the germs of discharging 
pus infections or of skin disease. The best protection is to 
keep persons with such lesions from the house. When the 
history of a newly employed servant is not known, it is the 
part of wisdom to have her excretions examined for typhoid 
bacilli and at the same time to have any suspicion of tubercu¬ 
losis, venereal disease, or skin infection put at rest by a 
medical examination. 

Washing of Dishes.— Considerable comment has centered 
recently on the possible transmission of respiratory disease 
by dishes. Ordinary washing and wiping of dishes does not 
sterilize them, and germs can remain on a dish or collect into 
the dish towel for transfer to another. The dishes used by 
patients with tuberculosis have been found after washing to 
retain virulent tubercle bacilli; germs of acute sore throat 
and other conditions appear also to live through the process. 
All public eating houses are required by some communities 
to have the dishes washed in very hot water by a dish washing 
machine; this is a wise ruling where a plate used by one rush- 
hour patron is hurriedly washed and put before another. 

Such transmission of mouth contamination is possible in 
private homes if an infected patient or carrier is in the house, 
though there are many readier avenues of transmission. 
The plate which is passably cleaned, wiped, and put away 
until the next meal, is less dangerous than the air of the room 
where the patient sits. Sloppy washing of dishes in the home 
appears not to transmit disease to any extent. It does breed 
carelessness and in other minor ways is objectionable. A 
more sanitary method is that by which the dishes are rinsed 
in a pan of very hot water after washing, and then set aside to 
dry by evaporation. Drinking glasses used by person after 


HEALTH IN THE HOME 


225 


person, and not washed at all between, are much more likely 
than the dishes to transmit any contagion that someone in 
the house might have. 

Safe Water and Ice.— In communities without a properly 
supervised water supply, or in rural homes, the danger of 
infection often lurks in the water itself. Drainage from 
excreta wash over the ground and into the well, either about 
the pump or through fissures in the soil; the shallow well on 
low-lying ground is most liable to pollution. Unless labora¬ 
tory test dispels suspicion, such water is safe for drinking or 
for the washing of foods only when boiled. 

The practice of icing water has been criticized because of 
possible pollution from the pond from which the ice was cut. 
Freezing for a period of months is unfavorable to bacterial 
life but it does not kill all bacteria, especially where the ice 
is snowy with air bubbles. The danger in America is a 
rather remote one, though polluted natural ice has caused 
typhoid fever here. Artificial ice is of course free from this 
danger. 

It has been thought by some that iced water is chemically 
or physically unsuited for drinking, particularly for those 
overheated by exercise. The only demonstrable objection 
to heavily iced water is that it chills the throat unpleasantly; 
the assumption that there are likely to be bad after-effects 
is hardly confirmed by experience. No harmful chemicals 
are present in the natural or artificial ice of the market. 

Cooling of Water and Food.— Such cooling in the summer as 
makes drinking water palatable commends itself, just as 
does the cooling of butter. Where ice is not available, a 
degree of coolness for foods is obtained by pits dug in the 
ground, by water running from beneath the ground, or by 
containers cooled by draughts and evaporation. To employ 
this last method, a small pan containing the food is placed 
in a larger pan of water, a coarse cloth covering the small 
pan and hanging about it into the water; when this device is 
placed in a draught, the moisture in the cloth keeps evaporat¬ 
ing and absorbing heat from the container, and meantime 
more moisture draws into the cloth by capillarity. 

The ice-cooled refrigerator, while superior to the crude 
15 


226 


THE FOUNDATION OF HEALTH 


devices just mentioned, often fails to cool well. Cheaply 
made refrigerators have variable humidity and, what is 
worse, variable temperature. Points of good construction 
include insulation, means for circulation of air, and a rela¬ 
tively large ice chamber. Even the properly constructed 
box is at its best only when well stocked with ice. A ther¬ 
mometer should be used to control the temperature, all foods 
being kept below 55° F. and some, including milk, at least 
10° lower still. Unless one of the shelves for food registers 
such a temperature, milk and other articles which support 
rapid bacterial growth are best kept in the ice chamber. 
Meat should not be kept directly on the ice as it absorbs 
moisture there. 

Safe Meats.— Cooling of foods in the kitchen is more that 
they may keep longer and taste better than for the prevention 
of disease. Only in the case of milk has the latter been shown 
to be a real factor. Decomposition of meats appears not to 
endanger health, for development of poisonous decomposi¬ 
tion products ( ptomains ) does not occur until after that of 
a disagreeable smell and taste. The decayed protein is unfit 
for food even though disease is not a proved danger; bad 
eggs have never poisoned anyone, but nobody wants to eat 
them. It is possible that the warmth and other conditions 
which hasten decay could also favor the growth of any infec¬ 
tive bacteria that chance to contaminate the meat. 

Meat killed and delivered directly to the butcher is not 
subject in this country to any sanitary regulation, and is 
more likely to harbor germs of disease than is the meat killed 
at large plants and kept in cold storage until delivered. Not 
only does the U. S. inspection in such plants keep much of 
the dangerous meat from the market, but cold storage is 
an additional safeguard. The freezing temperature slowly 
kills bacteria, and it more rapidly destroys larvae tapeworm. 
The trichina withstands freezing longer, but cannot live 
more than a few weeks through the storage temperature 
below 12° F., where a suspected meat should be placed. 
Cold storage makes meat tenderer, and for most people 
improves the taste. Meats from animals killed locally are 
more likely to be infected with animal or bacterial parasites. 


HEALTH IN THE HOME 


227 


Butchers have sometimes sold meat from animals killed 
because of tuberculosis or acute infection; if not cooked until 
well done throughout, such meat could transmit tuberculosis 
or the diarrheal type of food poisoning. 

Meat may also be bad due to improper handling while 
in the butcher shop. In making chopped meat, butchers 
have been known to use all sorts of scraps, including not only 
meats of a different sort from that represented but also meats 
on the point of going bad. Unless the butcher is known to 
be reliable, it is safer to buy desired cuts and chop them at 
home. Contamination also reaches meats and other foods 
from flies and general handling, unless the foods are sheltered; 
those foods which require no further cooking need sheltering 
more than raw meats. 

Kitchen Precautions.— Activities of the housewife which 
would safeguard the healthfulness of what she serves, in 
brief summary, are: (1) The exclusion from the kitchen of 
infected persons or carriers; (2) care in the selection of foods 
and water supply; (3) the heating before serving of any sus¬ 
picious water, milk, meat or canned goods; and (4) general 
cleanliness. Cleanliness is perhaps most essential in putting 
up canned foods, as this is the primary preventive of botulism. 

Corrosion of kitchen vessels is not the common source of 
poisoning it was once thought to be. Verdigris could hardly 
prove to be poisonous in the minute quantity that mixes 
into a food from properly cleaned vessels, even though 
copper should come into contact with the food. There is 
no greater danger in the fact that tin is dissolved into so 
many canned acid foods, for as in the preceding case the 
quantity never reaches poisonous proportions. Cheap grade 
enamelware might impart antimony to foods, but also in 
non-poisonous amounts. 

Garbage.— The standing about of neglected food waste 
does not lead to disease; it is unsanitary principally because 
it attracts flies, roaches and mice. The disposal at home of 
wet garbage is best brought about by burning, unless there 
are chickens or other animals to be fed. Garbage can be 
quickly dried and charred in iron baskets constructed to fit 
into the lower stove pipe, though such a device is superfluous 
with a fire hot enough to consume it immediately. 


228 


THE FOUNDATION OF HEALTH 


Nearly all large communities maintain public systems of 
garbage disposal. In some cities ashes, dry rubbish, and 
kitchen waste are collected into one wagon. In others the 
ashes are not removed by the municipality at all. In still 
others the rubbish and the kitchen waste are removed sepa¬ 
rately. Local conditions determine the best collection system, 
and with whatever system is in force the householder should 
carefully cooperate. 

Wet kitchen waste ought in any event to be kept until 
collected in a tightly covered can which permits no ingress 
of flies or mice. Compound cresol solution poured into the 
bottom of the can when emptied helps to check the decompo¬ 
sition of food residues or the breeding of flies. 

Insect Pests.— The riddance of insect pests and other 
vermin is by elimination of any food supply and breeding 
ground for them, by the proofing of houses against their 
entrance, and by destruction of those that do get in. All 
within the house may be attacked on a large scale by fumiga¬ 
tion. Fumigation, at its best, rids the house of roaches, bed¬ 
bugs, flies, mosquitoes, ants, fleas, and lice, as well as of 
rats and mice. The insects which do not fly can be attacked 
on a small scale by the use of petroleum or kerosene. These 
oils, or certain disinfectant solutions, or boiling water, are 
all insecticidal, but they kill only the insects which they can 
actually soak. Their use is adapted to the cracks in furni¬ 
ture; pests might be diminished in number sometimes by 
their use in cracks about the floor or walls. 

Fumigation.— The most effective, but in unskilled hands 
the most dangerous, exterminating procedure is fumigation 
with hydrocyanic acid. The gas is exceedingly poisonous to 
all forms of animal life; many fatalities to human beings 
have resulted from its use. A comparatively safe fumigant 
is the gas evolved from burning sulphur. After the sealing 
with gummed paper of all cracks about windows and else¬ 
where, ordinary sulphur is broken into small lumps in a pan, 
2 to 4 pounds being allowed for each 1000 cubic feet of space 
to be fumigated. This pan is put into a tub which contains 
a little water, so that the spluttering of burning sulphur 
might not set fire to the place. A few ounces of alcohol is 


HEALTH IN THE HOME 


229 


poured over the sulphur and this lighted. After exit is 
made, the last of the craeks are sealed and the place left 
until next day. 

The gas evolved is destructive to insects in either dry or 
moist atmosphere, though one fumigation usually fails to 
kill all that are present. Sulphur has but a fraction of the 
efficiency of hydrocyanic acid gas. In the presence of mois¬ 
ture it is injurious to many metals and fabrics. In spite 
of these disadvantages, it is the best method of fumigating 
for general use against insects. In bactericidal power sulphur 
fumes are inferior to formaldehyde fumes, but the reverse 
obtains as to insecticidal power. 

Flies and Mosquitoes.— Mosquitoes are best reached through 
the control of their watery breeding place, wherever that 
may be. The one which transmits yellow fever, and prob¬ 
ably dengue (Aedes oegypti: Stegomyia fasciatus ) breeds by 
preference in vases, old cans, barrels, and other receptacles 
about the house; its control depends more on the householder 
than does the control of the malaria mosquito, which breeds 
in the broader expanses of water. The most prolific breeding 
place of flies is the collection of manure about stables; they 
also breed in garbage and other decaying organic matter. 

Mosquitoes and flies, as well as other flying insects, are 
kept out by screens or exterminated by swatting. Sticky 
paper is fairly effective against the fly, but the traps available 
have proved less so. Flies should be attacked early in the 
season; few live through a cold winter, but unless these few 
are killed enormous multiplication takes place as warm 
weather comes on. Houses too often are insufficiently 
screened, and the householder should see to it each year 
that no open space remains about screen doors and windows. 
Netting is sometimes needed over the bed in addition, when 
mosquitoes are bad; it is also useful to protect the baby 
when sleeping in the yard. 

Mice and Rats.— Rats and mice, in addition to having 
other offensive qualities, are transmitters of disease. Germs 
which cause the diarrheal type of food poisoning are in some 
cases carried by rats and mice, and from the bowel passages 
of the rodents reach the food of human beings. Infectious 


230 


THE FOUNDATION OF HEALTH 


jaundice is brought from the rat to man, apparently through 
the same transmission route; this is an epidemic disease of 
the rat and of man which prevails widely in Japan and has 
also invaded America. Foods should be protected from the 
trespassing of rodents. The rat is the natural victim also 
of bubonic plague and trichiniasis, and occasionally of rabies; 
these infections also are passed on over various routes to 
man. 

New traps of the trigger and strong spring type commend 
themselves for the extermination of rats and mice; used 
traps are less to be depended on as the animals avoid traps 
which bear the odors of previous use. Exclusion of rats is 
brought about by the rat proofing of houses, though mice 
manage often to be carried past the barrier and then multiply 
in the house. To exclude rats, any openings into floors and 
walls from about the foundations are closed with cement, 
and to avoid harboring them in piles of lumber and junk about 
the house, these are put in order and raised from the ground 
on trestles. 

Household Pets.—The odor of cats and dogs deters rats 
from invading the house, though these pets are too well fed 
as a rule to care much about rats and mice. Dogs and cats 
may themselves transmit disease. Rabies is acquired and 
passed on to man by either of them, more often the dog. 
The common tapeworm of the dog (.Dipylidium caninum), 
which is also common in cats, has been transmitted through 
the dog flea to the intestines of children, in which it can then 
develop. Echinococcus disease is contracted by people in 
play or other association with infected dogs. 

The worm called echinococcus (Echinococcus granulosus) 
is a member of the tapeworm family, and is the member which 
creates the most serious human disease. The adult lives in 
the intestine of dogs and not like the pork, beef and fish 
tapeworms in that of man, but because its larva invades 
human tissue it is a far greater peril. The larvae in human 
tissue often die there, but sometimes their development 
continues until the disease reaches a fatal termination; the 
only active treatment is surgical removal of the encysted 
larvae. 


HEALTH IN THE HOME 


231 


Cats and dogs have many good points, chief among which 
is their companionship for children, but they are safe only if 
closely watched. They should be kept free from intestinal 
worms and other infections, and as free as possible from fleas. 
The anti-flea crusade by owners of dogs is a continuous one. 
Treatment of the animal’s infections by worms or other 
parasites requires some skill, and unless the owner has had 
considerable experience with animals this is best put in the 
hands of the veterinarian. Many have brought misery and 
even death to their dogs by a more or less regular diet of 
cathartics and other unnecessary drugs. Neither animals 
nor men thrive on unskilled doctoring. 

First-aid Kit.—For children and others of the family, the 
promiscuous administration of drugs affects health adversely 
rather than favorably. The household medicine chest is 
almost a thing of the past, and it should be. The practice of 
accumulating medicines has nothing in its favor. Drugs 
are rarely helpful except for a condition under treatment by 
the physician, and any remains of them are useless after the 
illness has passed. The medicines worth keeping are only 
the few for emergencies, which find a place in the first-aid 
kit. 

The first-aid kit for the household need not be nearly as 
well stocked as that for industrial plants. Much of the 
emergency treatment for poisoning can be provided from 
the kitchen, and much of that for mechanical injury from 
the sewing-room. The kit is needed principally for super¬ 
ficial cuts, lacerations, and burns. It serves but a small 
part of the general field of first aid, the essential to which is 
the idea of what should be done; materials can usually be 
found with which to do it. 

The household kit should have a few packages of sterile 
cotton and of sterile gauze, some gauze bandages, a spool of 
adhesive tape, a clinical thermometer, a bulb or “ear and 
ulcer” syringe, a few medicine droppers, and a hot-water 
bag. A few remedies to be included are plain petrolatum, 
tincture of iodine, a solution of one of the silver antiseptics 
such as 15 per cent argyrol and some crystals of potas¬ 
sium permanganate and of boric acid, to be dissolved when 


232 


THE FOUNDATION OF HEALTH 


needed. Possibly a dose or two of some purgative for use in 
case of poisoning would be worth including. 

Reading. * 

General, Pyle, Section by D. H. Bergey. 

Healthy Homes, Scurfield, Chapter II. 

Health, Land and Housing, Brend, Chapter V. 

Bacteria and Poison Gases in the Air, Rosenau, Section 
VI, Chapter IV. 

Adulteration of Food, Woodman and Norton, Chapter 
VIII. 

Extent and Kinds of Food Poisoning, Jordan’s Food Poi¬ 
soning, Chapter I. 

First-aid for Surface Injuries, Lynch, Chapter IV. 


* See bibliography for titles and publishers of books. 


CHAPTER XIV. 


THE MODERN HEALTH MOVEMENT. 

Responsibility for Health.— Individual hygiene is at many 
points inseparable from the public welfare. The regard for 
health is the person’s own privilege only insofar as the weal 
of others is not interfered with, and even his own physical 
condition affects the community, for his work must repay it 
for sustaining him. The agitators for public health can 
fairly assert that the maintenance of one’s health is a moral 
obligation as well as a personal privilege. They cannot 
stipulate how each is to live, for all individuals’ needs are 
not uniform, but they can demand a generally responsible 
attitude. 

A sense of responsibility has not yet developed in children 
and is often not present in those having a deficiency or 
derangement of mind, so these people cannot be expected 
to control their health; the burden is shifted to competent 
guardians. Those who are capable but simply too lazy to 
maintain judicious health standards cannot be given this 
justification. 

Hygienic Standards.— All mental competents have health 
principles of a sort, but the principles of many are based on 
momentary inclination rather than studied foresight. These 
prefer to gamble for their health, feeling that the odds are 
in their favor anyway, as the inherent elements of defense are 
strong, and that neighbors might be expected to lend a help¬ 
ing hand in emergency. Without bothering about health 
laws, they drift along and do as others seem to be doing; all 
goes well unless they chance to hit a snag. 

When ailment comes they find a fad, developed from some¬ 
one’s chance impression of his experience. Excessive exercise 
is indulged in, with a view to working an infection out of the 


234 


THE FOUNDATION OF HEALTH 


system. They “ don’t give in to the invader, but stay at work 
through sheer will power and brave it out;” that kind of sheer 
will power is often what delivers them to the invader. The 
neck wrappings for sore throat might be commended, as 
they warn sensible passers by of contagion, but they are not 
worn for that purpose. Some careless person had started 
the fad and they simply picked it up. 

Health and Intelligence.— Only from the more careful 
observations of human experience can the mind construct 
a real defense against the antagonists to health. Actual 
causes must be related to actual effects. Lack of such back¬ 
ground has misled thoughtful as well as thoughtless persons. 
Some have drifted into the loose thought that all illness 
originates in the mind and is to be overcome simply by a 
different sort of thinking. Ills of the imagination have indeed 
been so cured, but not the havoc that is wrought by the germ 
of diphtheria and other disturbers of tissue. To have power 
over bodily health, the mind must appreciate and meet the 
body’s physical needs. 

Only with a basis of scientific hygiene can the individual 
meet his responsibility to the community, and relieve it of the 
necessity of issuing hygienic prohibitions to him. The right 
of others to prohibit anything from anyone is derived from 
the failure to fulfill obligations. How much justification 
there is for the prohibition of drugs or alcoholics depends on 
whether women and children must go hungry because their 
providers squander the week’s pay and otherwise neglect 
life’s responsibilities under the depressant influence. Control 
of his habits is a fundamental privilege and a duty of every 
individual who is mentally competent; if he accepts the 
responsibility for health, the control may be left with him. 

Expert Aids.— The obligation to guard his health should 
not even be negotiable, though some would have it otherwise. 
There are those who would pay their physicians so much 
annually to baby them along in health matters and free them 
from the care, but such a scheme is neither ideal nor generally 
practicable. The health of lower animals and of immature 
human beings must be controlled by heads wiser than their 
own, but we like to think that human adults could take 


THE MODERN HEALTH MOVEMENT 


235 


care of themselves. The fixed annual fee system has been 
described as a model one in wide practice among the Chinese, 
but this is a myth. Foreigners in China and in other places 
removed from the medical world contract with their physi¬ 
cians by the year, but they regard this as an unavoidable 
makeshift rather than a model system. It does not encour¬ 
age prevention, or if it does it is only by shifting the responsi¬ 
bility from careless shoulders. 

The individual is the one who actually controls his life 
habits, and he can be guided much better by understanding 
than by a physician’s orders. His rightful dependence on 
others is for preliminary enlightenment and for aid in those 
emergencies which of necessity lie beyond his control. He 
should know where his limitations lie, and beyond them how 
to select wisely the skilled aids on which he must depend. 
Scientific men have specialized in many fields of health 
work, and afford him the use of their expert and technical 
skill. 

Patent Medicines.—The aid proffered as expert is not always 
bona fide. The falsely pretentious patent medicine is sold 
under a pretence of scientific composition, and its ridiculous 
promise of healing potency is couched in medical phraseology. 
Investigators who produce remedies of real worth are more 
likely to publish their findings for the use of all humanity 
than to burden the patent office with them. The fake medi¬ 
cine is not actually patented either, nor in many instances 
do all the bottles have sufficiently uniform contents for 
patent, but it has a registered trade name and has come to 
be known as the patent medicine. 

The deception practised in the advertisement of these 
preparations has been widely exposed by public-spirited 
periodicals of recent years, and many publications have 
refused to accept their fraudulent advertising. The activi¬ 
ties of the Post Office Department, of the enforcers of the 
Food and Drug Act, and of various public health authorities, 
have further restricted the traffic. 

The proprietary medicines advertised to physicians only 
are by no means as great an evil, for the physician’s training 
saves him from being misled. The profit accrues to the pro- 


236 


THE FOUNDATION OF HEALTH 


prietor, as in the case of the patent medicine, but it is not 
this feature that hurts. An objection to these latter prepara¬ 
tions is the encouragement they give the physician to pre¬ 
scribe mixtures which approximately meet his patient’s 
requirements, instead of bothering to remember his thera¬ 
peutics and meet the conditions precisely. Another bad 
feature is the possible misuse of physicians’ reports on occa¬ 
sional patients who do well while using the treatment; such 
reports could be published by the proprietor company later 
as typical ones, should the advertising campaign be extended 
to the general public. 

Quack Doctors.— A more extortionate swindle than the 
patent medicine traffic is that of the medical quack, or self¬ 
advertiser. Some quacks advertise in the local papers, 
designate themselves as specialists, and solicit the diseased to 
call at their offices. Others advertise far and wide, and solicit 
only correspondence; they promise to cure conditions without 
even having seen them, and claim that diagnosis is possible 
from a filled-in questionnaire. 

The chief peril lies in the unscrupulousness and low medical 
caliber of the men in whom the victims come to place their 
confidence. The man who descends to quackery is the decid¬ 
edly low-grade physician, or sometimes is not really a physi¬ 
cian at all. Most of them operate in greater or less violation 
of the laws of their communities. Medical men whose 
experience and skill is such as to rank them as real specialists 
in any branch would be the last to advertise in the papers. 

Persons of limited means are led by “free examination” 
offers to think that the service will cost but little; after the 
examination they are frightened into parting with all their 
savings for unnecessary treatments. Others, who are averse 
to having their complaint known, are struck by the word 
“confidential” in the advertisement; the quack is the only 
physician who is likely to betray confidences, however, and 
some unrevealed chapter of a person’s affairs offers golden 
opportunity for blackmail. Letters received in response to 
advertisements are sold to letter brokers, to be rented out 
to any other swindler who wants a list of easily deceived 
people. 


THE MODERN HEALTH MOVEMENT 


237 


Medical Systems.— The practice of quackery enters into 
several “medical systems,” built on this or that pseudo¬ 
scientific fancy. The medically untrained practitioners may 
or may not first guess at the nature of the patient’s illness, 
and then they proceed with some more or less imposing 
semblance of a treatment. 

Characteristic of such systems is a fairly complete dis¬ 
regard of all careful observations on phenomena of disease. 
Their proponents decry State Laws which would require any 
extended amount of study as a prerequisite to practise; 
their aim is to collect fees rather than to overcome sickness. 

Some who advocate the right of the untrained to take 
medical fees have loosely leagued themselves together to 
fight for “medical freedom.” They clamor about despotism, 
and imply that doctors of medicine form a closed alliance 
which forbids any outsider to practise. Quite to the con¬ 
trary, the medical world is in no sense exclusive and would 
have all capable persons free to practise medicine. It knows 
and insists, however, that years of intensive study must 
underlie any capable direction of the conflict with death. 
The demand that practitioners be well trained is purely for 
the public interest; it is an insurance that those who treat 
a disease will know of the several factors involved. 

The respective medical systems endanger the public in 
proportion as their practitioners lack understanding. The 
old discordance between homeopathy and regular medicine is 
tending to disappear as the homeopathic colleges bring more 
scientific training into their courses of study. 

Regular Medicine.— Regular, scientific medicine has no 
orthodox principles of healing by which it differentiates 
itself from heterodox bodies; it is not a system based on any 
unique tenets. Its basic principle corresponds with that of 
any true science; it is to relate together all observed facts 
about the body and its diseases. False concepts will be 
weeded out, simply because they are out of keeping with other 
known facts. Any conflict in findings between different 
observers is tediously studied until the error appears. Med¬ 
ical science aims to interpret all of humanity’s experience of 
health and sickness. 


238 


THE FOUNDATION OF HEALTH 


The general practitioner has a broad grasp of the entire 
field of medicine. The management of conditions which 
require extraordinary skill is referred to the specialist who 
devotes himself more largely to that one class of conditions. 
The family physician can manage most cases quite as well 
as the specialist, and with much less inconvenience and 
expense to the patient. The growing tendency of patients 
to go directly to specialists has created a demand for over¬ 
specialization in medicine; young physicians are tempted to 
specialize early in one field and neglect the others, instead 
of superimposing any favored specialty on the broad experi¬ 
ence of a general practice. The family physician is the best 
judge of which cases need the specialists’ care. 

Medical Advice.— The physician’s contribution to the 
building up of diseased organs is advice, which it is then the 
patient’s responsibility to put into effect. The patient is 
still accountable for his health, though now he must not 
act entirely on his own judgment. A prescription of careful 
diet and tedious exercises, with possibly a medicinal mixture 
for some minor effect, cannot be expected to give results if 
the patient takes the medicine and neglects the other parts 
of the advice. 

In some ailments, the advice is that no known treatment 
can aid the recuperative powers of the body; in such a case 
it is useless for the patient to try one remedy after another. 
If the condition is not to improve right away and cannot be 
hurried, the logical management is to wait for it; its eventual 
cure should not be credited to a few bottles of whatever nasty 
fluid happens to have been taken in the meantime. The 
fondness of some people for medicinal treatment becomes 
almost a mania. They want treatment for a pulse-rate 
which differs from the average, or any other peculiarity 
which they chance to find; when the family doctor offers 
none they appeal to the quack. The disciples of “ medical 
freedom” are found more resourceful. An unreasoned accept¬ 
ance of professed healers has this danger, that false standards 
are not distinguished from true. 

Work on Animals. —Many false standards have appeared 
commendable to the thoughtless. Among these is the anti- 


THE MODERN HEALTH MOVEMENT 


239 


vivisection fanaticism. The practice of vivisection is taken 
by some people to indicate cold-hearted or even brutal 
impulses. The investigator is thought of, together with the 
boy who throws at birds and the dog that kills chickens, as 
one dominated by the primitive impulse of carnivora to 
inflict pain and destroy life. On the contrary, only the mind 
which has attained a fair plane of altruism would be attracted 
to scientific medicine. The medical man feels that men, 
women and children should be relieved of suffering and pre¬ 
mature death, at the expense of animal life if necessary. 

Even so, the animal experimentor is not the tormentor of 
animals that his adversaries paint him. A familiar rule in 
animal laboratories requires that anesthetics be employed 
wherever an operative procedure would cause more discom¬ 
fort than the anesthetization; only in the occasional experi¬ 
ments of such nature that their results would be vitiated, 
are exceptions made. When the animal’s death is necessary, 
it is not commonly one of suffering. 

Domestic animals drafted into laboratory service have 
their life prolonged or their lot otherwise improved in many 
instances. Sheep, for example, are kept for the occasional 
use of a little blood, instead of being slaughtered for food. 
The more customary laboratory animals, such as rabbits 
and guinea-pigs, lead also a generally comfortable existence; 
they live in much less fear of the scientist than did their wild 
ancestors of larger beasts. Many of them now are bred only 
for the laboratories, and if this use of them should cease they 
would not taste of life at all. 

Modern medicine and hygiene depends greatly on the 
employment of living animals for experimentation and other 
purposes. Animal experiments have made possible the per¬ 
fection of treatments, by which are cured innumerable 
attacks of sickness which would otherwise have proved fatal. 
Animal work is necessary also for the routine prevention, 
diagnosis, or treatment of many diseases. The lives of non- 
immune persons who have been exposed to smallpox, rabies, 
or tetanus are very greatly endangered unless specific meas¬ 
ures are taken, and these measures involve the operative use 
of cattle, rabbits, horses and guinea-pigs. The Wassermann 


240 


THE FOUNDATION OF HEALTH 


test for syphilis, and diagnostic tests of the same nature for 
other diseases, depend on the use of living sheep, rabbits 
and guinea-pigs. Guinea-pigs are used for the accurate diag¬ 
nosis of some forms of tuberculosis, white mice for that of 
pneumonia, and rabbits for that of the typhoid carrier con¬ 
dition. The use of horses, guinea-pigs and other animals 
enters into the manufacture of curative sera. Dogs are indis¬ 
pensable for some procedures, including the development of 
new surgical operations and of dexterity in the performance 
of old ones, which otherwise would sometimes be at the 
expense of human life. These are but a few of the many 
purposes for which laboratory animals are used. The anti¬ 
vivisection prejudice, if ever it should dominate legislation, 
would militate disastrously against progressive medicine. 

Autopsy.— In many kindly intentioned people also there 
has developed an unfortunate sentiment against the autopsy 
of deceased persons. The nature of a disease becomes known 
through the study of tissues which this disease has attacked. 
What knowledge we receive of this comes from postmortem 
examinations. The one desire of physicians asking permis¬ 
sion to do an autopsy is to ascertain and record such data as 
will clear up uncertain points, and correlate physical findings 
on the patient with the actual tissue reactions. Such informa¬ 
tion as this finds its way eventually into the written science 
of medicine. The sentiment which would have such a 
memorial of one’s deceased relative built into science, to 
save life in future generations, is surely finer than the senti¬ 
ment which holds back in order that the body’s form might 
remain complete for a short period after burial. Embalming 
can be done just as well after autopsy, though it takes a 
little longer and is more difficult for embalmers who are 
poorly trained. 

Sentiment and Health.— Sentimental shortsightedness can 
jeopardize health at many points. Patients with open lesions 
of tuberculosis insist on keeping in their presence healthy 
babies, and ignore the protests of health authorities who 
would remove a baby to save it from the disease. When 
children begin to chafe under the restriction, quarantine 
regulations are allowed by parents to be broken, and con- 


THE MODERN HEALTH MOVEMENT 


241 


tagion and death to be spread to friends. Kindly motives 
are prone to misdirection, unless enlightened. 

When enlightened, on the other hand, such motives form 
the real back-bone of accomplishment in the advancement 
of health. By their very nature they expand individual 
into community hygiene. What the public health move¬ 
ment most needs is more of such sentiment as would pro¬ 
mote intelligent cooperation. Underlying setbacks to most 
programs for public welfare have been a disregard for the 
welfare of others coupled with an ignorance of the issue. 

Public Health.— Everyone should comprehend the goal of 
the principal public health activities. Most of these are 
conducted by organized authorities which function under 
the local, State, or Federal governments, or under privately 
endowed institutions. 

The State governments have the greatest power over 
American public health. As most health problems are local 
in character, however, the legislatures delegate their control 
to the respective local communities; this is done through 
statute or provision in the municipal charters. A State 
Board of Health coordinates the work, acts in intercommu¬ 
nity affairs, advises local authorities legally, compiles vital 
statistics, maintains laboratories for the smaller communi¬ 
ties, etc. Local authorities are expected to look after the 
control of communicable disease, to have data registered 
for vital statistics, to guard the purity of public food supplies, 
to abate nuisances, and otherwise to safeguard the public 
health. Prime responsibility for a department’s conduct 
lies with the health officer, variously entitled, the amount of 
whose assistance depends on the size of the appropriation. 

Federal Activities .—Federal activity in health matters is 
concerned primarily with interstate and foreign problems 
only, but its influence is everywhere felt; it often comes into 
the State’s own confines by invitation. The Government’s 
health projects are distributed for execution among several 
of its departments, though at times the advisability of a 
consolidation has been considered. 

The Public Health Service under the Treasury Department, 
by inspection of immigrants and the quarantine and fumi- 
16 


242 


THE FOUNDATION OF HEALTH 


gation of ships, prevents importation from foreign countries 
of infectious diseases. The Service also operates the Hygienic 
Laboratories, inspects for purity the antitoxins and vaccines 
sold through interstate commerce, and publishes much general 
information on health matters. The Bureaus of Chemistry 
and Animal Industry under the Department of Agriculture 
include among their activities, respectively, an oversight 
of the pure food regulations, and an inspection of meats and 
investigation of dairies. Statistical material useful for the 
guidance of health campaigns is collected by the Bureau of the 
Census in the Department of Commerce. Child and infant 
welfare is investigated and promoted by the Qhildren’s 
Bureau of the Department of Labor. The Departments of 
War and of the Navy do active sanitary work in areas occu¬ 
pied by their forces. Important though less extended health 
work is conducted by other departmental agencies. 

Public Support.— The first of the demands made on the 
public by these many activities is that they be adequately 
financed. The scope of the local health work done is governed 
by the appropriation, and in all communities more funds 
would bring more results. It is generally true, though rarely 
appreciated, that large appropriations for health work would 
prevent economic losses represented by a still greater figure. 
Not infrequently it is only by the help of philanthropists that 
the most necessary work can be done. 

A vote for increased taxes for health work does not, how¬ 
ever, fulfill the individual’s whole obligation; adequately 
financed work can have its effects dwarfed by public indiffer¬ 
ence. People accept without thought the advantages afforded 
by community life, and forget that some moral responsibili¬ 
ties go with them. Foremost among these are the hygienic, 
a disregard of hygiene being much more harmful among 
many people than among few. 

Eradication of Disease.— Nearly all campaigns for the eradi¬ 
cation of some disease from a community have been impeded 
by public indifference. Eradication of the hookworm 
demands merely that nobody go barefoot for a time, that 
bowel discharges be properly disposed of, and that patients 
diagnosed as having the disease take treatment. Unfortu- 


THE MODERN HEALTH MOVEMENT 


243 


nately, it is among the relatively untaught that hookworm 
most prevails, and commissions find that such people insist 
on their own way of dressing and of excreta disposal, that 
they are insulted if told that their leisurely habits are due to 
worms, and that they will not trouble to come for treatment. 
Yellow fever eradication demands that there be no breeding 
about the houses of a certain mosquito, but in spite of the 
sanitarians’ appeal water continues to stand in cans thrown 
into the yard. Stamping out of smallpox epidemics by 
vaccination has always been hampered. Many who stand 
to gain most from the campaigns show the least enthusiasm 
for them. 

Vital Statistics.— It is not only the untaught whose cooper¬ 
ation fails to materialize. Consider as an instance the col¬ 
lection of material for statistics. The charts for the conduct 
of health campaigns are drawn from statistics. Many 
conditions of life bear on the conflict of tissue with disease; 
age, race and occupation influence the issue less directly 
but often as really as does a wide prevalence of the germs. 
When the communities are charted, all these conditions are 
entered. Data are registered in the health office, and other 
data are collected through the United State and local census 
by house to house canvass. Registered data include deaths 
and their causes, births, and the occurrence of certain of the 
diseases; the proportion in the community of old people, of or 
negroes, or of indoor workers, is learned through the census. 
Private canvasses are frequently made for various other 
information. 

Too often the registration of facts wanted is neglected, or 
the census takers are avoided. Many would withhold from 
investigators all personal information. The most influential 
people of the community are often the worst offenders. 
Statements made to census takers are offhand and careless. 
A third more people state their age at thirty, or forty, or 
fifty years, than at thirty-one or any other intervening figure; 
in a hurried brevity they do not pause to think what their 
actual age is. The value of any chart depends on its accuracy, 
and the accuracy of these charts requires public cooperation. 


244 


THE FOUNDATION OF HEALTH 


Child Welfare.— A field of health work now coming into 
prominence deals with the welfare of children. Probably no 
work depends more than this on wide popular support; even 
its supervision must have the effort of others than the health 
authorities. It has called forth the united efforts of health 
departments, schools, charitable institutions, welfare organ¬ 
izations, public spirited physicians, and newspapers; if 
enough followers will support these leaders in the work, the 
problem will be on the way to solution. Children of pre¬ 
school age are the hardest to reach, as the older ones are in 
touch With the school system. 

All children have the right to a fair start in life; those who 
do not get it at home can look only to the community, whose 
future strength will depend largely on the start now being 
given them. Yet, there are many people who do not even 
realize that such a public problem exists. When a new 
problem is brought to their attention, they do not take the 
trouble to comprehend it. Comprehension of others’ needs 
and some concern over them is the only sound basis for a 
public health interest. 

Advance of the Health Movement.— The instances cited 
of indifference to public health measures are impediments, 
but fortunately are not dominating ones. The health picture 
as a whole gives no occasion for pessimism. Enormous 
strides have been made in the saving of life. Some diseases 
have been eradicated from communities where they had 
flourished, and others take but a fraction of the lives that 
they formerly did. 

Diseases of such nature as to yield to known hygienic 
measures are causing smaller and smaller proportions of the 
death list, as the years go by. Infant mortality and the 
mortality from infectious diseases of childhood, from malaria, 
from yellow fever, from typhoid fever, from tuberculosis, 
from smallpox, and from other preventable diseases, have 
steadily decreased. More of the people live on until they die 
of the diseases of advanced age, or of other conditions which 
public health measures cannot as yet affect. In twenty 
years the proportion of deaths in America attributed to 
tuberculosis, typhoid fever, diphtheria, and infants’ diarrhea, 


THE MODERN HEALTH MOVEMENT 


245 


lor instance (A in Fig. 20) was cut down more than one- 
third; that attributed to apoplexy, organic heart disease, 
nephritis, and cancer (B in Fig. 20) rose correspondingly. 
The death-rate of early life has been dropping, and the 
average span of life thereby lengthened. 



Fig. 20.—Preventable compared with non-preventable disease. 


The health movement quite clearly has prolonged lives 
and added to the health and happiness of life. As its scope 
widens there will be still fewer discomforts, and fewer deaths 
except from diseases of old age. Its goal has been expressed 
as the prevention of all preventable diseases. This goal is 
still a distant one, but as the average person becomes more 
interested and enlightened in health values it will be the 
more rapidly approached. 

Reading. * 

General, Hill, Chapters X to XIII. 

Advertising Specialists and Nostrums, Nostrums and Quack¬ 
ery, Respective Sections. 

Scientific Medicine, J. F. Williams, Chapter V. 


* See bibliography for titles and publisher of books. 








246 


THE FOUNDATION OF HEALTH 


The Community Attitude, Hough and Sedgwick, Chapter 
XXXIV. 

Functions of the Board of Health, Lee, Chapters XXIII 
and XXIV. 

The Public Health Movement, Rapeer, Chapter II. 
Development of American Public Health, Hemingway, 
Chapter II. 


GENERAL BIBLIOGRAPHY. 


Angell, J. R.: Introduction to Psychology, Henry Holt & Co. 
♦Bancroft, J.: The Posture of School Children, The Macmillan Com¬ 
pany. 

Billings, F.: Focal Infection, D. Appleton & Co. 

♦Bowers, E. F.: Bathing for Health, E. J. Clode. 

Brend, W. A.: Health and the State, Constable & Co., London. 

♦Cabot, R. C.: A Layman's Handbook of Medicine, Houghton, Mifflin 
Company. 

♦Camp, W.: Handbook on Health, D. Appleton & Co. 

Chandler, A. C.: Animal Parasites and Human Disease, John Wiley 
& Sons. 

Chapin, C. V.: Sources and Modes of Infection, John Wiley & Sons. 
♦Chapin, H. D.: Health First, The Century Company. 

Cornell, W. S.: Health and Medical Inspection of School Children, 
F. A. Davis & Co. 

♦Cromie, W. J.: Keeping Physically Fit, The Macmillan Company. 
Curtis, H. S.: The Play Movement and Its Significance , The Macmillan 
Company. 

♦Fisher, I., and Fisk, E. L.: How to Live, Funk and Wagnalls Company. 
Grulee, C. G.: Infant Feeding, W. B. Saunders Company. 

Harvey Lectures, published yearly, Lippincott. 

Hemenway, H. B.: American Public Health Protection, Bobbs-Merrill 
Company. 

Herrick, C. J.: Introduction to Neurology, W. B. Saunders Company. 
♦Hill, W. H.: The New Public Health, The Macmillan Company. 
♦Hough, T., and Sedgwick, W. T.: The Human Mechanism, Ginn & Co. 
fJoRDAN, E. O.: General Bacteriology, Seventh Edition, W. B. Saunders 
Company. 

fJoRDAN, E. O.: Food Poisoning, The University of Chicago Press. 
♦Lee, R. I.: Health and Disease, Little, Brown & Co. 

♦Lynch, C.: American Red Cross Abridged Text-book on First Aid, P. 
Blakiston’s Son & Co. r ~ N ) 

Mathews, A. P.: Physiological Chemistry, Wm. Wood & Co. 

*Nostrums and Quackery, American Medical Association Press. 

♦Pusey, W. A.: The Care of the Skin and Hair, D. Appleton & Co. 

♦Pyle, W.: Personal Hygiene, W. B. Saunders Company. 

♦Rapeer, L. W.: Educational Hygiene, Charles Scribner’s Sons. 

♦Reik, H. O.: Safeguarding the Special Senses, F. A. Davis Company. 
Rosenau, M. J.: Preventive Medicine and Hygiene, Fourth Edition, 
D. Appleton & Co. 

♦Scurfield, H.: Infant and Young Child Welfare, Cassell & Co., London. 

* The more popularly written are marked with asterisk, 
f References to Jordan are to the General Bacteriology except where 
Food Poisoning is specified. 


248 


GENERAL BIBLIOGRAPHY 


Sedgwick, W. T.: Sanitary Science and the Public Health, The Mac¬ 
millan Company. 

Sherman, H. C.: Chemistry of Food and Nutrition, The Macmillan 
Company. 

*Terman, L. M.: Hygiene of the School Child, Houghton, Mifflin Com¬ 
pany. 

Tyler, J. M.: Growth and Education, Houghton, Mifflin Company. 

♦Vaughan, V. C.: Poisonous Proteins, C. V. Mosby Company. 

♦Williams, H. S.: Adding Years to Your Life, Hearst’s International 
Library Company. 

♦Williams, J. F. : Personal Hygiene Applied, W. B. Saunders Company. 

♦Winslow, K.: Prevention of Disease, W. B. Saunders Company. 

♦Woodman, A. G., and Norton, J. F.: Air, Water and Food, John Wiley 
& Sons. 

♦Woodworth, R. S.: The Care of the Body, The Macmillan Company. 

* The more popularly written are marked with asterisk. 


INDEX 


A 

Absorption of food, 108 
Accidents, 28, 213 
Accommodation, visual, 154 
Aches, 157 

Acid corrosion, 47, 110 
Acidity of stomach, 104, 135 
Acne vulgaris, 38 
Acquired resistance, 20 
Active immunity, 75, 81 
Acute disease, 70 
sore throat, 58 
Adenoids, 120 
Adhesions, 101 
Adolescent insanity, 212 
Adrenal glands, 86 
Adulteration of foods, 142 
Agar-agar, 26 
Air, 123 

Air currents, 129, 220 
Alcoholism, 175 

Alimentary intoxication, 132, 202 
Amino acids, 134 
Ammoniated mercury, 39 
Amoebic dysentery, 64 
Analgesics, 158 
Animal parasites, 24, 64 
experimentation, 238 
Anthrax, 43 
Antibodies, 73 
Antidotes for poisons, 110 
Anti-fat diet, 143 
Antisepsis of bowel 108 
Antiseptics, 27, 223 
Antitoxin, 74 
Antivenins, 76 
Apoplexy, 163, 196 
Applied hygiene, 201 
Arch supports, 192 
Argyrol, 28, 63 
Arsenic poisoning, 110 
Arteriosclerosis, 196 
Artificial respiration, 118 
ventilation, 130 


Ascaris, 66 

! Asexual reproduction, 85 
Aspirin, 59, 158 
Assimilation of foods, 135 
Association tracts, 169 
! Asthenopia, 154 
Astigmatism, 156 
Athletics, 18, 186 
Attention in study, 169 
Auerbach’s plexus, 105 
; Autopsy, 240 
j Autumn hay fever, 83 


B 

Bacilli, 25 
| Backache, 160 

| Backwardness in school, 171, 210 
Bacterial culture, 26 
vaccines, 79 

Barriers to disease, 20, 69 
Bathing, 36 
| Bath itch, 36 
J Belching, 104 
Benign tumors, 48, 87 
J Benzol poisoning, 117 
i Bichloride poisoning, 110 
Bile, 107, 138 
Birth control, 93 
Black eye, 45 
| Blackheads, 37 
Blastomycetes, 24 
I Bleaches, hair, 33 
1 Bleeding, superficial, 45 
Blepharitis, 62 
Board of Health, 241 
Body cells, 31, 85 
heat regulation, 124 
louse, 41 
Boils, 38 
! Boric acid, 28 
Botulism, 75, 111 
l Breathing, 118 
Breath, odors in, 53 




INDEX 


250 


Broken arch, 192 
compensation, 196 
Bromidrosis, 40 
Bronchial tubes, 117 
Bruises, 45 

Bubonic plague, 42, 80 
Burns, 46, 215 
Butchers, 227 

C 

Caffeine, 174 
Calcium in diet, 145 
Caloric feeding, 140, 147 
Camping, 214 
Cancer, 48, 54, 86 
Canker sores, 61 
Carbohydrates, 138 
Carbolic acid poisoning, 110 
Carbon dioxide, 124 

monoxide poisoning, 117, 220 
Carbuncle, 39 
Carcinoma, 48, 54, 86 
Caries of teeth, 51 
Carriers of disease, 55, 223 
Catarrh, 120 
Cathartics, 113 
Cells of body, 31, 85 
Centipede sting, 77 
Cerebral hemorrhage, 163, 196 
Cervical adenitis, 72 
Chancre, hard, 95 
Chapping of skin, 35, 130 
Charley horse, 194 
Chemical dermatitis, 47 
Chemotherapy, 82 
Chicken pox, 205 
Childbirth, 90 
Child hygiene, 201, 244 
Chlorination of water, 67 
Cholera, 64, 79 
infantum, 132, 202 
Chorea, 93, 165 
Chromatin, 85 
Chronic disease, 70 
Chyle, 108 
Chyme, 101 
Cinder in eye, 63, 158 
Circulatory defect, 109, 196 
system, 36, 193 
Cleansing of skin, 35 
Clothing, 126 
Coal dust, 121 

gas poisoning, 117, 220 


I Cobra venom, 75 
Cocci, 25, 38 
Coffee, 174 
Cold baths, 36 
cream, 33 
Colds, 60, 131 
Color blindness, 91 
of clothing, 127 
Comedones, 37 

Communicable disease, 56, 203 
Community hygiene, 18, 233 
Companionship, 177 
Complexion, 33 
Complication of disease, 71 
Compound cresol solution, 27, 223 
Concentration in study, 171 
Conception, prevention of, 93 
Condiments, 106 
Congenital disease, 91 
syphilis, 97 
Conjunctiva, 61 
Conjunctivitis, 61 
Connective tissue, 31 
Consciousness, 162, 170 
Constipation, 113 
Consumption, 122 
Contact infection, 56 
Contagious disease, 56, 203 
Convalescent carrier, 56 
Cooling of foods, 225 
Corns, 45 

Corrective exercise, 188 
Corrosive chemicals, 47 
Cosmetics, 33 
Cotton clothing, 126 
Court plaster, 166 
Crab-louse, 41 
Cramps, occupational, 165 
swimmers’, 19, 197 
Criminal abortion, 94 
Culture media, 26 
Curative medicine, 29 
Curling irons, 33 


D 

Dandruff, 37 
Deep breathing, 118, 198 
Defective traits, 29, 91 
Deficiency disease, 144 
mental, 93, 171, 211 
Deflected septum, 120 
Delicate children, 209 





INDEX 


Delirium tremens, 175 
Dementia precox, 212 
Dengue, 42, 229 
Dental floss, 52 
Dentistry, 53 
Depressants, mental, 173 
Derma, 31 
Dermatitis, 35, 47 
Desks and posture, 190 
Detached home, 217 
Diabetes, 139 
Diaphragm, 118 
Diarrhea, management of, 115 
Dietary deficiency, 144 
Diet for infants, 147 
general, 107, 134 
Digestive system, 101, 198 
Diphtheria, 60, 75, 204 
Disaccharides, 138 
Discipline of children, 184 
Disease germs, 23 
Dish washing, 224 
Dislocations, 189 
Dizziness, 161 
Dogs, 43, 230 
Domestic hygiene, 217 
Dominant traits, 93 
Drowning, 118, 215 
Drug habit, 158 
Dust inhalation, 121, 221 
Dyes, hair, 33 
Dysentery, 64 
Dysmenorrhea, 89 
Dyspepsia, 106 


E 

Ear wax, 152 
Echinococcus, 230 
Educational exercises, 199 
Elimination of heat, 125 
of waste, 36, 137 
Emotion, 105, 176 
Endocarditis, 71 
Enemas, 113 
Energy metabolism, 138 
Enlarged glands, 72, 211 
Enteritis, 111 

Environmental hazards, 19 
Epidermis, 31 
Equilibrium of body, 161 
Eradication of disease, 242 
Esophagus, 103 


! Eugenics, 93 
Eustachian tube, 50, 60 
Exercise, 114, 186 
Exercises of baby, 187 
External ear, 152 
Extractives in diet, 146 
Eye, 153 
Eyestrain, 154 


F 

Face powder, 33 
Fainting, 163 
Fallen arch, 192 
Fallopian tubes, 89 
Fancy diet, 106 
Fatigue, 195, 221 
posture, 191 
Fats in diet, 139 
Federal health authorities, 241 
Feeble mindedness, 93, 171 
Feedings for babies, 106, 147 
Felon, 44 
Fever, 124, 198 
Fibrous tissue, 31 
Filterable virus, 25 
Finger-nails, 44 
First-aid kit, 231 
Flat-foot, 192 
Flavorings in diet, 146 
Fleas, 42, 228 
Flies, 68, 229 
Flukes, 25 

Fly-borne disease, 68 
Focal infection, 71 
Follicular tonsillitis, 58 
Folliculitis, 38 
Food poisoning, 110, 227 
values, 140 
Foods, 134 
Foot gymnastics, 192 
Footwear, 45, 128, 191 
Foreign body in ear, 152 
in eye, 63, 158 
in throat, 104 
Formalin, 27 
Fractures, 158, 189 
Freckle cream, 33 
Fried foods, 106 
Frostbite, 46 
Fumigation, 228 
Fungous parasites, 24, 39 
Furunculosis, 38 



252 


INDEX 


G 

Garbage, 227 
Gas heating, 219 
poisoning, 117, 220 
Gastro-intestinal tract, 103 
Gauze masking, 57 
General paresis, 96 
practitioner, 238 
resistance, 23 
German measles, 204 
Germ-cells, 87 
Germicidal soaps, 223 
Germicides, 27 
Germs of disease, 23 
Gigantism, 86 
Gingivitis, 52 
Glands, 35, 85 

Glandular enlargement, 72, 211 
Glycerin suppository, 115 
Glycogen, 86, 139 
Gonorrhea, 61, 97 
Gonococcal ophthalmia, 61, 99 
Gumma, 96 
Gymnastics, 187 

H 

Habit, 170 
forming drugs, 158 
spasm, 166 

Habitat of bacteria, 26 
Hair, care of, 33 
Hangnail, 44 
Hard chancre, 95 
Hasty eating, 106 
Hay fever, 83 
Hazards to health, 19 
Head louse, 41 
Headache, 159 
Health ideals, 18, 233 
certificate, 91 
stories, 207 
Hearing, 152 
Heart defect, 196 
Heat exhaustion, 164 
rash, 37, 132 
regulation, 124, 198 
stroke, 164 
Heating of house, 218 
Hemoglobin, 123 
Hemophilia, 91 
Hemorrhage, 45, 163 
Hemorrhoids, 195 


I Hereditary disease, 28, 91 
Heredity, 20, 92 
Hernia, 102 
Hiccoughs, 119 
Hives, 82, 137 
Homeopathy, 237 
Hookworm, 66 
Hordeolum, 62 
House cleaning, 222 
flies, 68, 229 
sanitation, 217 
Humidity, 130, 218 
Huntington’s chorea, 93, 166 
Hydrophobia, 43, 80 
Hygieia, 17 
Hyperopia, 156 
Hyphomycetes, 24 


I 

Ice, 225 
Idiocy, 171 
Immunity, 70 
Impetigo contagiosa, 39 
Incubation period, 56, 78 
Indigestion, 106 
Individual hygiene, 17 
Industrial accident, 28 
poisoning 117 
Infanticide, 94 
Infantile paralysis, 55, 188 
Infants’ diarrheas, 115, 202 
diet, 106, 147 
Infection, 24, 69 
Ingrowing nails, 45 
Inheritable disease, 28, 91 
Insanity, 173 
Insect-borne disease, 42 
Insects, 77, 228 
Insomnia, 180 

Inspection of meats, 65, 226 
Interest in study, 170 
Interstitial cells, 86 
Internal respiration, 123, 138 
secretions, 85 
Intestinal antisepsis, 108 
worms, 24, 65 
Iodine, 28, 110 
Iritis, 62, 71 
Iron in diet, 145 
Irrigation, cleansing, 28 
Itch mite, 38, 40 
Ivy poisoning, 47 




INDEX 


253 


K 

Kidney inflammation, 137, 197 
Kitchen precautions, 227 
Koplik spots in measles, 204 
Kyphosis, 191 

L 

Leakage of heart valves, 196 
Left-handedness, 169 
Leucorrhea, 100 
Leukocytes, 38, 71 
Lice, 41 
Light, 136, 154 
Lime in diet, 145 
Liquid petrolatum, 114 
Liver medicines, 108 
Lobar pneumonia, 121 
Lockjaw, 75, 166 
Locomotor ataxia, 96, 161 
Lordosis, 191 
Lungs, 117 
Lymphadenitis, 72 
Lymphatics, 72, 195 

M 

Mad-dog bite, 43, 80 
Malaria, 42, 82 
Malignant tumors, 48, 87 
Malnutrition, 143, 208 
Malposition of uterus, 89 
Marriage, eugenic, 91 
Masks, gauze, 57 
Mastoiditis, 153 
Masturbation, 94 
Measles, 204 
Meats, 64, 226 
Mechanical injury, 23, 28 
Media for bacteria, 26 
Medical advice, 238 
systems, 237 
Medicine chest, 231 
Meissner’s plexus, 105 
Membranous coverings, 50 
Memory, 170 
Mendelian inheritance, 92 
Menstruation, 88 
Mental disease, 173 
processes, 168 
Mercurial ointment, 41 
Metabolism, 136 
Metal dusts, 121 
Mice, 229 


Middle-ear disease, 60, 153 
Migraine, 160 
! Milk-borne disease, 67 
pasteurization, 67, 208 
teeth, 53 

Mind, hygiene of, 168, 199 
Mineral oil, 114, 138 
salts, 145 
Moles, 48 

Monosaccharides, 138 
! Morons, 171 
Morphinism, 110, 158 
Mosquitoes, 42, 229 
Mouth breathing, 120 
washes, 51, 223 
Mucous membranes, 50 
Mucus, 51 
Mumps, 205 
Muscular system, 186 
Mushrooms, 122 
Music at meals, 106 
Myopia, 157 

N 

N^vus, 48 
1 Nails, 44 
Narcotics, 158 
| Nasal obstruction 119 
! Natural resistance, 20 
Negri bodies, 80 
Neoplasms, 48, 86 
I Nephritis, 197 
Nerve endings, 31, 150 
Nervous breakdown, 181 
Neurasthenia, 154, 182 
Neuritis, 71 

j Neuro-muscular system, 186 
Neurosis, 164 
! New-growths, 48, 86 
j Nicotine, 174 
' Nits, 41 

Nocturnal emissions, 89 
j Normal diet, 134 
! Nucleus of cell, 31, 85 
j Nutrient enema, 135 
Nutrition, 134, 209 

O 

i Oak, poison, 47 
Obesity, 143 

Occupation, selection of, 173 
i Occupational neuroses, 165 



INDEX 


254 


Occupational poisoning, 117 
Oil pores, 35 
Open-air school, 210 
Opium poisoning, 110, 158 
Organized play, 213 
Orient, sanitation of, 17, 64 
Otitis media, 60, 153 
Outdoor exercise, 199 
Outer skin, 32 
Ovary, 88 
Overeating, 142 
Overrepair of tissue, 20 
Overweight, 143 
Oxalic acid poisoning, 110 

P 

Pain, 157 
Paraffin oil, 114 
Parasites, 23, 69 
Paratyphoid fever, 64, 80 
Paregoric, 158 
Passive immunity, 74, 81 
Pasteurization, 67, 208 
Pasteur treatment, 80 
Patent medicines, 109, 235 
Pathogenic bacteria, 27 
Pediculosis, 41 
Pellagra, 144 
Pelvic deformity, 90 
Period of incubation, 56, 78 
Peristalsis, 103 
Peritoneum, 101 
Pets, 230 
Phagocytes, 70 
Pharyngitis, 60 
Physical exercise, 186 
defects, 210 
Phytotoxins, 75 
Pigmented mole, 48 
Piles, 195 
Pimples, 37 
Pinworm, 66 
Pituitary body, 86 
Plague, 42, 69 
Plant parasites, 24, 39 
Play, 212 
Play-grounds, 212 
Playmates, 177 
Pneumococcus, 60 
Pneumonia, 60, 121 
Poisoning, 110, 117 
Pollen sensitiveness, 83 
Polysaccharides, 138 


i Postmortem examination, 240 
| Posture, 188 
Powder, face, 33 
Precocious children, 172 
Pregnancy, 89 
Preservatives for food, 112 
Preventive medicine, 29 
Prickly heat, 37, 132 
Prodromes of disease, 22 
Prohibition, 234 
Proprietary medicines, 235 
I Prostitutes and disease, 98 
| Proteins, 78, 134 
Protozoa, 25, 87 
Psychoses, 173 
Ptomain poisoning, 111, 226 
Puberty, 88 
Pubic louse, 41 
Public Health Service, 241 
hygiene, 18, 241 
I Punishment, 178 
Purification of water, 66 
| Pus, 38, 70 
Pyemia, 71 
Pylorus, 104 
Pyorrhea, 52 

Q 

Quackery, 236 
Quarantine, 56, 203 
Quinine, 82 

R 

Rabies, 43, 80 
Radiotherapy, 136 
Rats, 229 

| Rattlesnake bite, 76 
Raw surfaces, 44 
Reading glasses, 157 
Recessive traits, 93 
j Recreative exercise, 199 
j Red blood cells, 123 
Reflex arc, 150 
Refractive error, 156 
I Refrigeration, 225 
Regular, medicine, 237 
j Regularity of meals, 106 
Relative humidity, 130 
Reproductive function, 85 
j Resistance of body, 20, 70 
' Respiratory infection, 55, 121 
tract, 117, 198 




INDEX 


Retarded study, 171, 210 
Rheumatism, 71, 98 
Rickets, 136, 188 
Ringworm, 39 

Rocky Mt. spotted fever, 42 
Roentgen-ray, 136 
Root abscess, 53 
Rouge, 33 

Round worms, 25, 65 
Rupture, 102 

S 

St. Vitus’s dance, 165 
Salts in diet, 145 
Sanitation, 18 
Scabies, 40 
Scaling lids, 62 
Scalp, care of, 33 
Scar formation, 31 
Scarf skin, 32 
Scarlet fever, 205 
Schaefer’s artificial respiration, 
Schick test, 206 
Schizomycetes, 24 
Scientific medicine, 237 
Scoliosis, 191 
Scorpion sting, 77 
Screening, 229 
Scurvy, 144 
Sebaceous glands, 35 
Second sight, 157 
Selective survival, 20 
Seminal emissions, 89 
Senses, 151 
Sensory nerves, 150 
Sentiment, 178 
Septicemia, 71 
Septum deflection, 120 
Serum, antitoxic, 74 
sickness, 82 
Sex education, 94 
Sexual reproduction, 87 
Sewer gas, 118 
Shallow breathing, 118 
Shoes, 45, 128, 191 
Sick headache, 160 
Skin, 31 
Sleep, 179 

Sleeping sickness, 42 
Smallpox, 81, 205 
Smoke, breathing of, 121 
Smoking, 105, 174 
Snakebite, 76 


Soap, 35, 223 
Soothing syrup, 158 
Sore throat, 58 
Specialists, 238 
Specific resistance, 22, 206 
Spermatozoa, 88 
Spiced diet, 106 
Spinal curvature, 190 
Spirilla, 25 

Spirochaeta pallida, 95 
Spirochetes, 25, 95 
Split protein theory, 78 
Spoiled children, 182 
Spores, 27, 87 
Sprains, 189 
Spring fever, 162 
Squint, 155 
Stammering, 165 
Statistics, 243 
Stomach, 104 
Stimulants, mental, 173 
Stinging insects, 77 
Strabismus, 155 
Strangulated hernia, 102 
Streptococci, 38, 72 
Stuttering, 165 
Stye, 62 

Sugars in diet, 138, 146 
Sulphur ointment, 40 
Summer camping, 214 
diarrhea, 132, 202 
diet, 142 
Sunburn, 46 
Sun glasses, 157 
Sunlight, 136, 157 
Sunstroke, 164 
Suppuration, 39, 70 
Survival theory, 20 
Sweat, 36, 125 
glands, 34, 36 
Swimming, 19, 215 
pools, 214 

Sydenham’s chorea, 165 
Syphilis, 95 

Systems of medicine, 237 

T 

T A. 75 
Tabes, 96, 161 
Taeneae, 65 
Tan creams, 33 
Tapeworm, 25, 65 
Tarantula sting, 77 



256 


INDEX 


Tartar, 52 
Taste and diet, 146 
Tea, 174 
Team play, 199 
Teeth, 51, 145 
Temperature of body, 124 
of house, 129, 218 
Testicles, 88 

Testicular transplants, 86 
Tetanus, 75, 166 
Thermic fever, 164 
Throat examination, 58 
sore, 58, 71 
Thyroid gland, 86 
Ticks, 42 

Tincture of iodine, 28 
Tineae, 39 

Tissue waste, 137, 197 
Tobacco, 174 
Toleration limits, 22 
Tonsil enlargement, 120 
Tonsillitis, 58, 73 
Tooth brushing, 52, 223 
decay, 53 

Toxin, antitoxin, 75 
Toxins, 24, 73, 

Trachoma, 62 

Transmission of disease, 55, 69 
Treponema pallidum, 95 
Trichiniasis, 65 
Tuberculosis, 122, 208 
Tuberculous glands, 72 
Tumors, 48, 86 
Turbinate enlargement, 119 
Typhoid fever, 64, 223 
vaccine, 80 
Typhus fever, 42 
Typists’ cramp, 165 

U 

Ultramicroscopic virus, 25 
Ultraviolet rays, 136 
Unconsciousness, 163 
Underclothing, 127 
Underweight, 143, 208 
Upper respiratory tract, 117 
Urticaria, 82, 137 
Uterine malposition, 89 

V 

Vaccines, 79 
Varicocele, 195 


I Varicose veins, 195 
Vasectomy, 89 
I Vasomotor nerves, 162 
| Vegetable parasites, 24 
I Venereal disease, 95 
| Venoms, 75 
i Ventilation, 128, 220 
Vermifuges, 66 
| Vertigo, 161 
[ Vincent’s angina, 60 
j Viperine snakes, 76 
Virulence of bacteria, 27 
( Visceroptosis, 101 
i Visual accommodation, 154 
j Vital centers, 162 
resistance, 20 
statistics, 243 
J Vitamins, 51, 144 
Vivisection, 238 
Vulvovaginitis, 99 

W 

j Warm baths, 36 
| Warmth of fabrics, 126 
j Warts, 48 

Wassermannn test, 96 
Waste elimination, 36, 137 
Water, drinking, 66, 225 
Wax in ear, 152 

I Weight, average, 143, 202, 209 
Whipworm, 66 
I White-blood cells, 38, 71 
! Whooping-cough, 204 
| Will power, 169 
Winter itch, 36 
Woolen clothing, 126 
Worms, intestinal, 24, 65 
Worry, 176 
Wounds, 44, 70 
Writers’ cramp, 165 

X 

X-RAY, 136 

Y 

Yeast fad, 145 
Yellow fever, 42, 229 

Z 

Zinc poisoning, 117 
Zootoxins, 75 





















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